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TABLE OF CONTENTS
[Trends in...] [Parental Processes...] [Adolescent Sexuality...] [Conclusions] [References] [Tables]
Family Relations: Vol. 49, No. 2, pp.
143–154.
Adolescent Sexuality and Parent-Adolescent
Processes: Promoting Healthy Teen Choices*
Laurie L. Meschke, **
Suzanne Bartholomae, and Shannon R. Zentall
Received 3-23-99
Revised & Resubmitted 9-21-99
Accepted
11-08-99
| Trends in adolescent sexual health, the relation between
parenting and adolescent sexual outcomes, and adolescent sexuality
interventions with a parent component are reviewed. American
adolescents have higher rates of unprotected sex and STI contraction
than adults and nine times the teen pregnancy rate of their European
counterparts. Parenting efforts are related to adolescent sexual
behavior. The review of 19 relevant programs supports the
incorporation of theory and the ecological model in program design and
evaluation. |
Keywords: adolescence, intervention, parents,
programming, sexuality, trends.
The health of adolescents is greatly determined by their behavior
(Adams, Schoebom, Moss, Warren, & Kann, 1992 ; Alan Guttmacher Institute [AGI], 1994 ; Chassin, Presson, Sherman, & McConnell, 1995 ; U.S. Department of Health and Human Services [DHHS], 1998b
). An important and complex area of adolescent behavioral health is
sexuality. Issues of experience and activity include the timing of first
intercourse, number of sex partners, contraceptive use, pregnancy, and
sexually transmitted infections (STIs). Each of these outcomes vary within
and between ages, gender, race (Children's Defense Fund [CDF], 1991 ), socioeconomic
status, and religious groups (Coley & Chase-Lansdale, 1998 ; Katchadourian, 1990 ; Miller, 1998 ).
Complexity is also reflected in the particular influences
associated with adolescent sexual activity (AGI, 1994 ; DHHS, 1995 ). Neighborhood (socioeconomic status,
joblessness), peer (sexually active friends), familial (family instability,
single-parent household, sibling sexual activity), and individual
characteristics (race, gender, age, pubertal status) have all been
associated with adolescent sexual outcomes (see AGI, 1994 ; Bearman & Brucker, 1999 ; Brewster, 1994 ; Brown & Theobald, 1999 ; Child Trends, 1997 ; Coley & Chase-Lansdale, 1998 ; Hogan & Kitagawa, 1985 ; Miller, 1998 ; Sucoff & Upchurch, 1998 ). Given the severity of
negative consequences associated with sexual activity, ensuring that youth
receive sexuality education is important for healthy development.
Researchers have found parents to be the primary sex educators of children
(DHHS, 1996 ), as less than 10% of youth report having had
comprehensive sexuality education programs in other settings (Donovan, 1989 ; Klein & Gordon, 1992 ). Researchers also suggest that
adolescents who feel a personal connection to family are at less risk of
participating in risky behaviors, including early initiation of sexual
intercourse (Resnick, et al., 1997 ). Therefore parents as educators,
in conjunction with positive family relationships, are essential for healthy
adolescent development.
The association of family processes with adolescent sexuality has
led to the development of a number of adolescent health promotion programs
with a parent component (see Table 1 
). These programs have
goals such as increasing comfort levels when discussing sexual issues,
increasing adolescents' and their parents' knowledge and awareness of sexual
issues, and preventing adolescent health risks, such as pregnancy and STIs.
Although evaluations have been limited, programs that have been evaluated
have proven to be somewhat successful.
The purpose of this paper is threefold. First, current trends in
adolescent sexual behavior are considered. Next, the associations of family
factors and processes with adolescent sexuality are examined. Finally,
current adolescent sexuality programs with a family component are reviewed.
Recommended directions for future work in each of the three sections are
also addressed.
Trends in Adolescent Sexual Behavior Return
to TOC
The past four decades have been a period of great change in
adolescent sexual activity and its consequences. Adolescents are initiating
sexual activity at younger ages (DHHS, 1995 ), and teen pregnancy rates are now declining
since their peak in 1991 (Child Trends, 1997 ). Important trends in the area of
adolescent sexual behavior include sexual experience and activity,
pregnancy, and STIs, including the human immune deficiency virus (HIV) and
the acquired immune deficiency syndrome (AIDS).
Regarding sexual experience, approximately 12.1% of males and 3.0%
of females aged 18–21 reportedly have had sexual intercourse by 12 years of
age. The largest increase was among 15-year-old females who reported having
sex—a jump from 5% to 25% between 1979 and 1988 (DHHS, 1995 ). For over 20% of these young women, early
sexual initiation (14 years or younger) was not voluntary (Abma, Driscoll, & Moore, 1998 ; Child Trends, 1997 ). Early initiation of sexual
intercourse (age 14 or younger) has been related to lower contraception use
and higher risk of pregnancy (DHHS, 1995 ).
The likelihood of sexual activity increases with age. Over twice as
many 18 to 21 year old adolescents (78.9%) are sexually experienced compared
to their 14 and 15-year-old counterparts (31.6%) (DHHS, 1997 ; DHHS, 1998a ). However, the percent of high school
students reporting ever having sex declined from 54% in 1990 to 48% in 1997
(Annie E. Casey Foundation, 1999 ). Data indicate that
during the 1990s sexual abstinence increased slightly for males, whereas
females reported a slight decrease. In 1995 among sexually experienced
adolescents, 27% of females and 37% of males, aged 15–17, reported
abstaining from sexual intercourse for the three months preceding the
survey. These figures were up from the 1988 percentages of approximately 24%
and 33%, respectively. However, supplemental 1997 data from a sexually
active, in-school sample of 15–17 year old adolescents indicate that 23% of
females and 34% of males reported abstaining from sexual intercourse (DHHS, 1999 ; DHHS, 1998a ).
Adolescent contraceptive use has also increased over the years (AGI, 1994 ; Adams, et al., 1992 ). The Center for Disease Control and Prevention [CDC] (1997)
reported that between 1990 and 1997, 15- to 19-year-old males and
females increased their condom use. An 11% increase occurred for females
(40–51%) and a 14% increase for males (49–63%) (CDC, 1998b ). However, adolescent contraceptive use
remains lower than that of adults (CDC, 1997 ).
Despite the increased proportion of youth practicing protected
intercourse, adolescents are disproportionately at risk for STIs. STI rates
have declined among the total population, however the rate of decline among
adolescents has not been as great (DHHS, 1995). In 1995, an estimated
two-thirds of the 12 million STI cases occurred among individuals under the
age of 25. In 1997, 15- to 19-year-old adolescents had the highest gonorrhea
rate among all age groups and accounted for one-third of all gonorrhea cases
in the United States. The total population had gonorrhea rates of 123 cases
per 100,000, compared to 699 cases per 100,000 among 15- to 19-year-old
adolescents (DHHS, 1998b).
Many reasons are behind the large number of adolescents (ages 10 to
19 years) contracting STIs. Compared to other age groups, teens are more
likely to have multiple sex partners, engage in unprotected sex, and choose
higher risk partners (CDC, 1997 ). Among the serious effects of STIs are
impaired fertility, reproductive tract cancer, adverse pregnancy outcomes,
and the transmission of HIV infection (DHHS, 1995).
Adolescents are also among the groups most at risk for contracting
HIV (DHHS, 1997). A report released April 1998 revealed that worldwide, five
adolescents aged 10 to 24 are infected with HIV every minute, resulting in
2.6 million new infections each year. Of those acquiring HIV after infancy,
more than half are adolescents (UNAIDS, 1998). Over the past decade the
number of U.S. adolescents (13–19 years of age) with AIDS has increased
substantially, from 53 adolescent cases in 1986 to 3,130 AIDS cases in 1997.
In the last 10 years the proportion of U.S. adolescent AIDS cases that are
female more than tripled, from 14% in 1987 to 46% in 1996. These HIV/AIDS
statistics are believed to be conservative estimates. A long incubation
period (up to 10 years) between HIV infection and an AIDS diagnosis provides
a measurement challenge (CDC, 1998a ; DHHS, 1995). Although a person may contract
HIV as an adolescent, a diagnosis may not be given until signs of the
disease occur, which is likely to be in adulthood. Sexual transmission is
the most commonly noted method of contracting HIV for adolescents. For male
adolescents, 49% of the diagnosed cases were attributed to sex with other
men. Of female adolescent HIV cases, 37% were contracted via heterosexual
contact, primarily with older men (CDC, 1998a ).
Another serious health outcome associated with lack of protection
during sexual intercourse is pregnancy (CDC, 1995 ). Although the teen birth rate has been
declining since 1991, it remains higher than the mid-1980s and higher than
other industrialized countries. The 1997 birth rate in the United States for
adolescents (15–19 years) was 52.3 live births per 1,000, down from 62.0 per
1,000 in 1991. Birth rates tend to vary across the country, with Mississippi
having the highest birth rate among teens aged 15- to 19-years old (75 per
1,000) versus Vermont with the lowest (30 per 1,000) (AGI, 1999 ). Compounding the problem, most teenagers who
give birth are unmarried. In 1950, 23% were unmarried compared to 84% in
1996 (CDC, 1998b ).
Teen pregnancy results in a constellation of personal and societal
problems. Adolescent mothers are more likely to experience poor physical and
mental health, educational attainment, employment and income, and a greater
level of financial dependence and poverty than their non-childbearing peers.
In addition, compared to children of older mothers, the children of teen
mothers are more likely to experience poor health, cognitive ability,
academic achievement, and social behavioral outcomes (see reviews Coley & Chase-Lansdale, 1998 ; Hayes, 1987 ; Jorgensen, 1993 ).
In relation to pregnancy outcomes, between 1985 and 1996 the
abortion rate among U.S. teens decreased by 31% to 29.2 abortions per 1,000
women aged 15–19. Nonetheless, over one-third of pregnancies among
adolescents age 15–19 ended in abortion in 1996 (AGI, 1999 ). Both behavioral and attitudinal factors have
been attributed to the declines including, increased emphasis on delaying
sexual activity; increased fear of contracting an STI; increased
responsibility toward casual sex and out-of-wedlock childbirth; and
increased use of contraceptives with prolonged effectiveness (e.g.
Norplant), as well as more effective use of contraception (Saul, 1999 ).
The likelihood of choosing abortion has been associated with both
individual characteristics (e.g., more ambitious students, higher
socioeconomic backgrounds, and more positive attitudes about abortion)
(Brazzel & Acock, 1988; Furstenberg, Brooks-Gunn, Chase-Lansdale, 1989)
and safe and proximal access to clinics (Moore & Caldwell, 1977 ; Murry, 1995 ). Compared to older women, abortion is
likely to result in more complications for adolescent females. They tend to
wait until later in the pregnancy to abort, due to denial of the pregnancy
or poor access to clinics (Borgatta, 1998 ).
Summary
Despite some improvement in outcomes associated with adolescent
sexual health, much room for improvement remains. Although the frequency and
number of adolescents engaging in sexual activity have decreased, the
percentage of adolescents initiating intercourse at an early age has
increased. Teen pregnancy rates have decreased slightly, however, U.S. rates
continue to surpass their 1980 rates and remain the highest of any developed
nation. Finally, the impact of the extreme rates of adolescent STI
contraction (including HIV) on fertility issues, cancer rates, and morbidity
remain to be seen.
Future Directions
Given the alarming statistics, it is clear that adolescent sexual
behavior warrants further attention. Although these research trends are
quite informative, more extensive efforts could be made to better monitor
adolescent sexual health. Several high quality longitudinal datasets (e.g.,
NLSY, NSAM, NSFG, Add Health) linking adolescent sexual activity to
demographic characteristics now exist, however, influential family and
developmental processes have been under examined. For example, the CDC's
Youth Risk Behavior Surveillance System collects health data representative
of U.S. high school students, however, family and developmental processes
are overlooked. A smaller representative sample in addition to the larger
sample could be tracked to assess developmental trajectories associated with
sexual behavior. If one data source tracked multiple adolescent sexual
behaviors and outcomes, person typologies could be created to monitor
multiple events for individuals across time. For example, the proportion of
early initiating adolescents who have had both multiple partners and one or
more STIs could be calculated and followed across time.
The data reviewed here also come from multiple sources. For
example, the Office of Disease Prevention and Health Promotion and the CDC
have been tracking the health status and risk factors of the general
population as well as special populations, such as adolescents and
racial/ethnic groups. Smaller areas, including counties or school districts,
should also be encouraged to track these trends in order to determine
geographic areas and persons in need of intervention programs. The next
section reviews the findings about the relation between parental factors and
adolescent sexual behavior.
Parental Processes and Adolescent Sexual Behavior Return
to TOC
The relation between parental process and adolescent sexual
behaviors has been researched thoroughly, but findings are mixed. In 1998
Miller published an extensive, comprehensive review of parental influences
on issues associated with adolescent pregnancy. Following a similar format
(Miller, 1998 ), the literature examining the association
of parental characteristics with adolescent sexual behaviors is reviewed in
this section. Attempts were made to focus primarily on literature of the
past decade. This review focuses primarily on communication, parental
values, monitoring and parental control versus adolescent autonomy, and
warmth and support.
Communication
Parent-adolescent communication and its correlation to adolescent
sexual behavior has been more thoroughly researched than any other parental
influence in this area. Despite this, little is known about the relation
between communication and adolescent sexual behaviors in general.
Specifically, no single aspect of parent-adolescent communication has been
consistently and directly linked to changes in adolescent sexual behaviors
(Jaccard & Dittus; 1993 ; Miller, 1998 ).
Evidence of the relation between parent-adolescent communication
and teen sexual behavior is mixed. Some investigators have found no relation
between parent/child communication and teen sexual behaviors (Casper, 1990 ; Handelsman, Cabral, & Weisfeld., 1987 ; Hovell et al., 1994 ; Miller, Norton, Fan, & Christopherson, 1998 ). Others
have related higher levels of parental communication to an increased
likelihood of adolescent intercourse (Widmer, 1997 ). Overall more frequent and positive
parent-adolescent communication has been most commonly associated with fewer
sexual partners and later and less frequent sexual activity (Jaccard, Dittus, & Gordon, 1996 ; Miller, Forehand, & Kotchick,1999 ; Leland & Barth, 1993 ). Indeed, enhancing
parent-adolescent communication is espoused as an important strategy in
promoting healthy adolescent outcomes (see Healthy People 2000 objectives,
DHHS, 1996).
Communication has also been linked to contraceptive use. The more
mothers talked to their sons about birth control the more consistently the
sons used birth control (Jaccard, et al., 1996 ). Girls whose mothers discussed
birth control were about half as likely to engage in sex and three times
more likely to use effective birth control than girls whose mothers did not
discuss birth control (Newcomer & Udry, 1985 ). It appears that
communication does not encourage dangerous adolescent sexual behavior.
Although general mother-adolescent communication has been related to less
frequent sexual activity and fewer sexual partners, mother-adolescent
communication about sex has not been significantly correlated with
adolescent sexual behaviors (frequency, number of sexual partners, age at
first intercourse, or condom use) (Miller, et al., 1999 ).
Higher quality communication has been related repeatedly to
decreased likelihood of intercourse, delayed first intercourse for sons,
decreased likelihood of daughters being pregnant, and increased
contraceptive use for daughters (East, 1996 ; Fisher, 1987 ; Leland & Barth, 1993 ; Pick & Palos, 1995 ). Parents perceived as less
supportive and yet discussed sexual issues had adolescents who reported more
sexual risk-taking than peers who perceived their parents as more supportive
and whose parents communicated about sexual issues (Rodgers, 1999 ). The quality of the parent-adolescent
relationship serves as a possible explanation for the mixed findings on the
relation between parental communication and adolescent sexual behaviors. The
quality of the communication and the supportive nature of the
parent-adolescent relationship require further examination.
A barrier to positive communication is parents' and adolescents'
difficulty in talking about sexual issues. Parental communication may be
impeded by fears of encouraging or frightening adolescents about sexual
behavior (Katchadourian, 1990 ). Fox and Inazu (1980) reported that the majority of
mothers in their study felt “very uncomfortable” discussing topics such as
dating, menstruation, sex, and birth control with their daughters.
Adolescents are equally as wary. In a more recent study, 45% of female
adolescents stated feeling “somewhat” to “very” uncomfortable talking with
their parents about these issues (Hutchinson & Cooney, 1998 ).
Communication about sexuality varies within the population of
adolescents and their parents. This variability has been related to
demographic factors like gender and ethnicity. In a 1998 retrospective
study, young women (19–20 years) reported that 73.8% of their mothers and
20.9% of their fathers had provided them with at least some information on
general human sexuality. However, these women also stated that the majority
of their parents did not talk about some important topics such as postponing
sex, sexual pressures, and sexually transmitted diseases, with the
contributions of fathers falling far below that of mothers (Hutchinson & Cooney, 1998 ). In a 1991 CDC study,
parental gender was most strongly associated with whether or not AIDS was
discussed. In both single and dual-parent households, mothers (74.2%) were
much more likely than fathers (48.9%) to discuss AIDS (CDC, 1991 ). Parents generally have talked to same-sex
children about sexual issues (Fisher, 1993 ). However, 87% of young women shared that
they wanted more information from their fathers (Hutchinson & Cooney, 1998 ).
Differences in the amount of sexual information given to
adolescents also appear to depend on the gender of the adolescent. In an
unpublished dissertation, Hutchinson (as cited in Hutchinson & Cooney, 1998 ) found that only one-third
of male adolescents reported receiving at least “some” information about
sexuality, compared to almost half of female adolescents.
Ethnicity and SES also have been related to parent-adolescent
communication. Non-Hispanics (63.4%) were more likely than Hispanics (51.7%)
to discuss AIDS with their children (CDC, 1991 ). African American parents reported discussing
more sexual risk topics with their adolescent daughters than Caucasian
parents (Hutchinson & Cooney, 1998 ). Regarding SES,
adolescents whose mothers attended college were more likely to talk to their
parents about sexual issues (Leland & Barth, 1993 ).
Parental Values
Parental values have also been associated with adolescent sexual
behaviors. In fact, following his review of the literature, Miller (1998) concluded that the quality of
parent-adolescent communication was related to a decrease in adolescent
sexual behavior by transmitting values about sexuality, not through the
obvious content of communication. Parental disapproval of teen sex has been
related to later onset of first sexual experience, having fewer sex
partners, less frequent sexual activity, and decreased teen pregnancy (Jaccard, et al., 1996 ; Miller, et al., 1999 ; Resnick et al., 1997 ). Fathers may play a particularly
important role. Teens, who perceived their fathers' disapproval independent
of their mothers' approval, delayed first intercourse (Dittus, Jaccard, & Gordon, 1997 ).
Religion can play a strong role in family socialization,
particularly in relation to values (Jenkins, 1991 ). For example, White, adolescent
fundamental Protestants reported a delay of first intercourse, whereas their
peers reported a decrease in age of first intercourse (Cooksey, Rindfuss, & Guilkey, 1996 ). Adolescent
denomination affiliation has been associated with risk of first intercourse
and contraceptive use, although the relation varies by race (Brewster, Cooksey, Guilkey, & Rindfuss, 1998 ).
Parental values may also be indirectly transmitted to adolescents.
Newcomer and Udry (1984) found that mothers who were
sexually active as adolescents were more likely to have adolescent daughters
who were sexually active. It is yet unclear whether this finding is due to
environmental influences (i.e., parental values) or heredity. Specifically,
pubertal timing is affected by heredity, which is subsequently associated
with age of menarche. In turn, age of menarche has been positively related
to the timing of sexual experience as mediated by association with older
males (Stattin & Magnusson, 1990 ).
Again, as with communication, it is possible that the effect of
parental values on adolescent sexual behavior is moderated by the quality of
parent-adolescent relationships. Parental values may be more influential if
the parents provided warmth and support to their teens. However, if parental
values were permissive then the adolescents' behaviors were more likely to
be more permissive (Moore, Peterson, & Furstenberg, 1986 ; Weinstein & Thorton, 1989 )
Monitoring and Control/Autonomy
Parental monitoring and control of adolescent activities are also
related to sexual behaviors. The majority of research supports the notion
that higher levels of parental monitoring promote the delay of first sexual
intercourse (Ku, Sonenstein, & Pleck, 1993 ; Danziger, 1995 ; Capaldi, Crosby, & Stoolmiller, 1996 ), a lower
number of partners and greater use of contraception (Luster & Small, 1994 ; Miller et al., 1999 ; Rodgers, 1999 ). This relation has occurred not only for
White adolescents, but also for African-American (Hogan & Kitagawa, 1985 ; Miller et al., 1999 ) and Hispanic youth (Hovell et al., 1994 ; Miller et al., 1999 ). Other researchers have found no
relation between parental monitoring and adolescent sexual experience.
However, adolescents who spent time alone at home (Perkins, Luster, Villarruel, & Small, 1998 ) or dated
alone (i.e., unsupervised) (Meschke, Zweig, Barber, & Eccles, in press)
were more likely to be sexually active.
Monitoring and control appear to have a curvilinear effect. Both,
too many rules and too little supervision, have been related to a greater
likelihood of adolescent sexual activity (Miller, McCoy, Olson, & Wallace, 1986 ). Daughters,
who felt controlled via high levels of maternal guilt, were more likely to
engage in risky sexual behaviors than their peers who did not perceive their
mothers as using guilt to control (Rodgers, 1999 ). However, a causal relation between
parental monitoring and adolescent sexual behavior cannot be determined. For
example, high levels of parental monitoring and various methods to control
adolescents may be a reaction to adolescent behavior, with antisocial
adolescent behavior potentially increasing parental rules and strictness (Miller, 1998 ). Given this, many unanswered questions
about parental monitoring and adolescent sexual behavior remain.
Warmth/Support
A close parent-adolescent relationship is important not only in
lowering adolescent sexual behaviors but also as a necessary part of
effective limit setting and communication (Jaccard, et al., 1996 ; Rodgers, 1999 ). When there is less adolescent closeness
with parents there is often an increase in peer influence on sexual issues
(Whitbeck, Conger, & Kao, 1993 ). Female adolescents
who held views similar to their peers were more likely to be sexually active
and less likely to consistently use contraception than their counterparts,
with views more like their parents (Shah & Zelnik, 1981 ).
In a study of 751 African-American adolescents (between 14 and 17
years), adolescents who had greater satisfaction in their relationship with
their mothers were less likely to be sexually active and initiated
intercourse later than adolescents with less satisfaction in their
relationship with their mothers (Jaccard, et al., 1996 ; Jaccard, et al., 1998 ). Higher levels of
parent-adolescent connectedness are also associated with a lower likelihood
of pregnancy among daughters (Resnick, et al., 1997 ). Overall, parental closeness to
and support for adolescents have been related to reduced adolescent sexual
activity and increased contraceptive use.
Other Influences
In addition to parent-adolescent relationships, characteristics of
families are also associated with teen sexual behavior. Socioeconomic status
has been linked to adolescent sexual behavior, primarily through levels of
income and educational attainment. Higher levels of income have been related
to later onset of sexual behaviors and lower teen pregnancy rates (Hogan & Kitagawa, 1985 ; Inazu & Fox, 1980 ; Lauritsen, 1994 ). Likewise, higher levels of parental
education have been associated with lower adolescent sexual activity, delay
of intercourse initiation, greater use of contraception, and lower risk of
pregnancy (Forste & Heaton, 1988 ; Hayward, Grady, & Billy, 1992 ; Kahn, Rindfuss, & Guilkey, 1990 ; Roosa, Tein, Reinholtz, & Angelini, 1997 ).
Parental marital status has also been related to adolescent sexual
activity. Adolescents, particularly females, living with one parent are more
likely to engage in early sexual behaviors and less frequently use
contraceptives than adolescents with two parents in the home (Hogan & Kitagawa, 1985 ; Ku, et al., 1993 ; Meschke, et al., in press; Miller & Bingham, 1989 ; Moore, Morrison, & Glei, 1995 ). Further, the early
onset of first intercourse has mostly been related to living with a single
parent, moderately related to living with stepparents, and least related to
living with biological parents (Day, 1992 ; Thorton & Camburn, 1987 ). However, these findings
may be due to a decrease in the number of parents available to monitor,
instead of simply a result of family structure alone.
Parental values may be more easily transferred to children when
they are living in the same house with their parents. Dittus, et al. (1997) discussed the importance of the
paternal disapproval of teen sex. They found that it was more difficult for
teens to perceive this disapproval when the father was absent. However, if
the teen did perceive their father's disapproval of teen sex, it moderated
the effects of his absence (Dittus et al., 1997 ).
Ethnicity may affect the degree to which parental marital status
influences adolescent sexual behavior. In a sample of adolescents from Black
and Hispanic families, after controlling for several demographic variables
including age, gender, and ethnicity, Miller, et al. (1999) found that family structure did not
significantly predict frequency of intercourse, number of sexual partners,
age at first intercourse or condom use. In a second study based on the same
sample, adolescents from single-parent families were positively influenced
by mother-adolescent communication about sex, which was not found in the
total sample (Kotchick, Dorsey, Miller, & Forehand, 1999 ). These
findings suggest that parental marital status and its interaction with other
factors regarding its relation to adolescent sexuality should be
investigated to a greater extent.
Summary
Adolescent sexual behaviors appear to be related to a number of
parental factors, including communication, values, monitoring and control,
and warmth and support. Findings on communication remain the most thoroughly
studied as well as the most inconclusive as to whether parent-adolescent
communication has a positive relation to adolescent sexual health. The type
of parent-adolescent communication (general or sex-specific) associated with
adolescent sexuality also requires further clarification. Parental values
seem to be related to adolescent values, and subsequently adolescent
behavior. Moderate amounts of parental control also appear to promote
healthy adolescent sexuality. However, warm, supportive parent-adolescent
relationships seem to be essential. Warmth and support appear to mediate the
association of communication, values, and monitoring with adolescent sexual
behavior. In other words, the amount of influence parents have on their
adolescents' sexual behaviors depends greatly on the quality of their
relationships.
Limitations and Future
Directions
Numerous issues are yet to be addressed when reviewing the research
on parent-adolescent relationships and adolescent sexual behavior.
Primarily, longitudinal studies that include self-reports from parents and
adolescents, similar to that of Capaldi, et al. (1996) , should be conducted in order to
investigate parental correlates from both parental and adolescent points of
view. Earlier studies focused almost exclusively on adolescent reports,
without taking parental perceptions into account.
Longitudinal studies should also address how parent-adolescent
relationships, that effectively influence healthy adolescent sexual
behaviors, develop over time. None of the studies included in this review
targeted populations younger than early adolescence. Little information is
available about the effect of the quality of early parent-child
relationships on subsequent child development and parent-adolescent
interactions. In addition, future studies of adolescent sexuality should
also examine parental influence after controlling for sexual socialization
that occurs outside of the parents, including school, religious, peer, and
sibling influence.
Continuity in the areas of communication, warmth, and monitoring
across the life of the youth also needs to be examined. Panel research
designs on family processes not only could follow these trends, but also are
likely to help explain the differences within and between families of
differing parental marital status, ethnicity, and other demographic issues.
Other factors such as frequency, consistency, and quality of family
processes, including monitoring and communication, have received little
longitudinal attention and constitute future research directions.
Few studies have examined the issue of gender differences in
parent-adolescent communications about sexuality. Discussions about sex with
opposite sex parents may be an important factor, especially given the
significant relation between paternal disapproval and adolescents'
abstinence from sex. Given the discrepant findings about the association of
parent-adolescent communication with adolescent sexuality as related to
gender, mother and father communication must be considered as unique
predictors of adolescent sexual behavior. In addition to comparing the
parents' communication, the interaction of the two also should be examined.
Finally, indirect types of communication, such as modeling, may be equally
or more influential than direct communication. These issues require further
investigation.
Evidence supporting the relation between parent-adolescent
processes and teen sexuality is quite strong. However, research alone does
not change adolescent decision-making and choices about sexual behavior.
This information must be disseminated to adolescents and their parents, who
can use the information to promote behaviors related to healthy adolescent
sexuality, including delaying first intercourse and exclusive participation
in protected sex. One dissemination method includes the development,
implementation, and evaluation of intervention programs for adolescents and
their parents. Current programs and their limitations are reviewed in the
following section.
Adolescent Sexuality Intervention and Parents Return
to TOC
Bronfenbrenner (1979) argued that the relation between
individuals and their environment can be tested via experimentation. A
treatment can be applied to manipulate the environment and, if the research
model is supported, the subsequent effect should be a change in the
individuals' behavior. Applying this argument to adolescent sexuality, an
intervention program could attempt to enhance parent-adolescent
communication (environment). If successful, change in communication should
in turn influence a predicted change in adolescent sexual behavior (e.g.,
delay of first intercourse). In other words, interventions are attempts to
manipulate the parent-adolescent processes relative to adolescent sexuality,
in order to promote healthy sexual behaviors (see Bogenschneider, 1996 for further clarification). Thus,
this strategy is a method by which to test theoretical models.
In general, research findings document that parent-adolescent
processes are more often associated with adolescent sexuality outcomes than
not, and yet the number of intervention programs designed to address this
association is quite limited. In a 1990 report for the Carnegie Foundation,
Small located ten adolescent sexuality programs with a parent component.
Coinciding with the increase of literature in this area and for the
purpose of this paper, a similar search in 1998 resulted in the location of
almost twenty programs (see Table 1 ). The search criteria
only required that the program be readily accessible nationwide (i.e.,
offered nationwide or available for purchase to potentially be implemented
nationally). The search included the Internet, several data bases (ERIC,
Psychlit, Psychinfo), and placing requests on various listserves composed of
professionals working in the areas of family, adolescence, and
intervention.
Table 1 provides an overview of
adolescent sexuality programs with a parent component now available
nationwide. Of the ten programs located by Small (1990) , only three (30%) are currently available:
PACT, Parent-Child Sex Education, and RSVP. The programs
available today differ in their strengths and approach to addressing
adolescent sexuality issues.
Current Status of Programming
Adolescent sexuality interventions with a parent component are
diverse on a number of issues including target audience, degree of parent
participation, program longevity, format, and evaluation. The most common
target audience is young adolescents. Sixteen of the 19 programs focus on
early adolescents, ages 10 through 14. Three of the programs, PACT,
Parent-Child Sex Education, and Plain Talk for Parents have
separate programs for young adolescents and older teens. None of the three
programs require that youth and their parents participate in more than one
of the age specific programs. However, the potential exists. The program,
Talking to Kids about AIDS, provides training for parents and other
invested adults in talking to grade school through high school youth about
AIDS. Although early adolescence is not the primary focus, they are included
in the programming effort.
Despite the majority of programs focusing on early adolescence, the
degree of parent involvement varies. Twelve of these programs focus equally
on parents and teens (e.g., FACTS and feelings), three focus
primarily on the parents (e.g., Plain Talk for Parents), and four
interventions target adolescents with an optional parent component
incorporated at the program's end (e.g., Stay SMART). The optimal
degree of parental involvement is not known and cannot be discerned from the
evaluation results provided.
The longevity of the 19 programs also varies considerably. Some of
the current programs, such as Parent-Child Sex Education and
PACT, have been available for a decade or more, whereas others like
Can We Talk? are just in their infancy, with project coordinators
still working to recruit participation sites. Based on the available
evaluation information, program longevity appears to have an impact on the
availability of evaluation information. Greater longevity also seems to be
related to the complexity of the evaluation design. Given the small number
of programs with evaluations, complex or otherwise, the statistical
significance of the relation between longevity and efficacy cannot be
determined.
Delivery methods also differ between programs. The location of
program implementation includes participants' homes, community sites, or in
some cases both. Homework accounts for the latter situation, with
participants completing assignments prior to the next session. Three of the
programs (FACTS and feelings, Growing Pains, and Talking About
Sex) are delivered exclusively in the participants' homes. These
programs consist of videos and/or newsletters. Seven of the programs are
implemented partially at community sites and partially at the participants'
homes. These programs include: Can We Talk?; Girl Talk; Girl Talk, Too;
Mother-Daughter Choices; PACT programs; Straight Talk; and
Talking to Your Children. The remaining nine programs are conducted
exclusively at community locations, the most popular implementation site for
teen sexuality programs with a parent component.
The time commitment required of participants, as related to
delivery style, also varies, given the different number of sessions provided
by the programs. Five was the average number of sessions in the programs,
with a range of three to ten sessions that included parents. Comparison
studies between the programs have not been conducted, therefore, the most
effective approach remains unknown.
Evaluation is the only means to determine program efficacy. Two
primary components have been associated with high quality evaluation: an
external or independent evaluator and a long-term follow up (see Kirby, 1997 for a thorough list of evaluation issues).
Having an external or independent evaluator helps ensure that the outcomes
are not the result of excessive data manipulation or fabricated data, as the
evaluator is not a personal stakeholder in the program. Long-term follow up
refers to data collection occurring a considerable amount of time after the
intervention. This design aids in confirming that the desired outcomes do
not disappear shortly after the program has concluded.
In reviewing the programs, four categories of evaluation emerge,
based on the evaluator and type of follow-up procedures utilized. The four
categories are: (1) Process Only (evaluation focuses on program
implementation and participant enjoyment), (2) Simple (internal or
external evaluator with a follow up taking place one month or less after the
program), (3) Intermediate (internal evaluator with long-term follow
up occurring more than one month after the program), and (4) Complex
(external evaluator and follow up of one month or more). These categories
aid in interpreting the overall evaluation quality of the current
programs.
Three programs have conducted a Process Only evaluation:
Can We Talk?, Girl Talk, Too, and Straight Talk. These
evaluations focus on implementation style and/or participant satisfaction.
Each of these programs is relatively new. Thus, it is important that
participants are satisfied with the program. If participants don't enjoy the
program, the chance of recruiting return or new participants decreases
greatly. Of the 19 programs, four fell into the Simple category,
having an internal or external evaluator with a short-term pre/post-test
follow up. The three other programs, It Takes Two, Plain Talk, and
Worth the Wait, all had external, long-term evaluations in the data
collection process. Thus, it appears that programs at this stage are well on
their way to meeting the criteria of the Complex stage of
evaluation.
Two programs have had internal evaluators, but meet the criteria of
having a long-term follow up evaluation. FACTS and feelings and
Girl Talk are in the Intermediate evaluation category. Despite
the use of an internal evaluator, the first program has evaluation results
published in a peer-reviewed journal (Miller, et al., 1993 ). This accomplishment strengthens
the credibility of the evaluation considerably and provides support for
conducting this type of evaluation.
The final evaluation category is Complex. Four programs met
the criteria of having an external evaluator and follow up data collection
occurring more than a month after the program's conclusion. Three of the
four programs, Stay SMART, Project Taking Charge, and PACT,
have been evaluated by outside universities. The results of the Stay
SMART (St. Pierre, Mark, Kaltreider, & Aikin, 1995) and Project
Taking Charge (Jorgensen, 1991 ) evaluations are published. However, the
parent component of Stay SMART is not included in this evaluation. An
independent evaluation firm has studied the fourth program, Parent-Child
Sex Education. Evaluators of both, this program (Kirby, 1985 ) and PACT, report a number of
significant findings, including an increase in parent-child communication
and parental sex knowledge (Cate, 1988 as in PACT, 1992 ).
Summary
Nineteen adolescent sexuality programs with a parent component that
are currently available nationwide were located. Great diversity exists
between programs. Most of the programs concentrate on early adolescents and
their parents and are conducted primarily in community locations, with an
average of five sessions per program. Evaluation efforts have also differed
substantially, ranging from process focus (participants' enjoyment) to
complex (external evaluator with long term follow-up). No evaluation
information was available for six of the programs. This review encourages
further development of adolescent sexuality programs with a parent component
and more evaluation to determine efficacy and the strengths of the various
approaches.
Limitations and Future
Direction
Despite programming variability, attempts have been made to
evaluate the current status of programs addressing teen sexuality with a
parent component. Thoughts on future directions follow in two sections.
First, recommendations based on the review of the current programs are
shared. Second, general recommendations based on current trends and
developmental literature are discussed.
Apply a broader lifespan approach. The primary target of
such programs is early adolescence. Given that the ultimate goal is to
promote healthy adolescent sexual behavior, early adolescence is an
appropriate age for intervention. Young adolescents are likely to be
sexually inexperienced (DHHS, 1995;
Miller, et al., 1986 ). However, sexuality issues do not
end once an adolescent reaches age 15, yet the majority of current programs
stop by this age. Sexuality is an ongoing issue that deserves to be
revisited on a regular basis. It is recommended that programs expand their
age focus and duration of intervention. Given the biological, social, and
cognitive development occurring during adolescence, it is likely that an
educational concept (e.g., orgasm or resistance skills) might sound foreign
at age 10, but may be thoroughly understood at age 15. Three of the 19
programs have sessions covering two or more age groups (PACT,
Parent-Child Sex Education, and Plain Talk for Parents).
Comprehensive interventions taking a broader life span approach should be
encouraged in order to optimize the chances of educating the adolescent in
an age appropriate fashion.
Strategize delivery methods. The current programs differ in
the amount of time that parents invest in the sessions and the location of
the intervention implementation. As stated earlier, the appropriate
evaluation to interpret which approach is most effective, has not been
conducted. However, previous studies report that parents prefer programs
that promote communication with their son or daughter, don't require much
time to complete, and can be completed in the home (Beck, et al., 1991;
Crockett, et al., 1989 as cited in
Toomey, et al., 1996 ). Reducing potential barriers to
parent participation could benefit programming efforts. With this in mind,
it would appear that the three programs (FACTS and feelings, Talking to
your children about sex, and Can we talk?) utilizing newsletters
and/or videotapes are most conducive to the schedules of parents and, thus,
may prove to be optimal.
Increase comparative research. Comparative research is
needed to determine how different approaches to intervention and their
efficacy might differ by family characteristics, including parental
employment, family composition, and ethnicity or individual characteristics,
such as age, developmental level, gender, or ethnicity. Different family
types are likely to have different needs. For example, race is argued to be
related to differing worldviews and socialization (e.g.,
Scott, 1993 ). Programming could be designed to address
specific familial or cultural needs. The Parent-Child Sex Education
program has somewhat unique programs for male and female adolescents, but
this is the extent to which diversity is expressed in current programming.
Increase quality of evaluation. High quality evaluation of
implemented programs should also be encouraged and address as many aspects
of programming as possible. Time and energy should not be devoted to
ineffective programs and efficacy cannot be determined without evaluation.
To help bridge program evaluation and basic research, studies and theories
should serve as a foundation in program development. Subsequently, program
evaluation could be conducted using all or some of the same measures used in
the research guiding the program design. For example, numerous measures of
parent-adolescent communication (see review by
Miller, 1998 ) have been developed and could easily be
incorporated into program evaluations. Consistency between previous research
and evaluation could eliminate one of the possible issues associated with
the lack of significant findings—inconsistent or inappropriate measures.
Evaluations should measure changes in behavioral outcomes, in
addition to measuring mediating processes such as parent-adolescent
communication. Consistent pre- and post-test instruments incorporating both
behavior change and mediation processes could benefit program evaluation and
the efficacy of interventions. Long-term follow up on changes of the target
behavior could also be conducted. Programs proven to be successful after
evaluation and replication in a variety of communities could be implemented
nationwide, thereby distributing the benefits of these programs'
generalizability.
Incorporate the ecological model. Beyond the recommendations
evolving from the review of the current programs, efforts also should be
applied to incorporating the ecological model (
Bronfenbrenner, 1979 ) in program development and
evaluation. Bronfenbrenner argued that in addition to proximal environments,
such as family interactions, the larger environment also influences
developmental outcomes. Indeed, in addition to parenting processes,
neighborhood or community issues have also been found to influence teen
sexuality (e.g., Brewster, 1994 ). Of the 19 programs reviewed, only one
teen sexuality program with a parent component made an attempt to include
community. Specifically, the PACT programs require “communities to
provide a structure whereby parents, organizations, agencies, and
institutions within each community coalesce efforts and resources to address
the problems related to adolescent sexual behavior and attitudes” (PACT, 1992 , page 2). This objective is enforced
primarily to help ensure that the program is sustained in the community,
following the facilitator training. In addition to the creation of such
program goals, evaluation efforts should be designed to understand if and
how these goals are achieved. It is imperative that program developers and
evaluators consider the contextual issues surrounding their intervention
efforts.
Cross cultural or multi-site comparisons. Given that the
U.S. has the highest teen pregnancy rates of industrialized nations and an
average age of first intercourse that has recently begun to slightly
decrease, it would seem that there is much to learn from other nations. For
example, the 1988 teen birthrate in the Netherlands was only 10 per 1,000,
compared to 97 per 1,000 in the U.S. (AGI, 1994 ). What is the Dutch approach to sexuality
education? Is such programming feasible in the U.S.? To date, a
cross-cultural comparison of program implementation and evaluation has not
been undertaken.
On a smaller scale, comparing the effectiveness of programs
implemented at different sites within the United States, including central
city, rural, and suburban contexts, would also be informative. Much can be
learned from effective programs replicated at multiple sites with multiple
audiences. To date, the evaluation of Project Taking Charge (Jorgensen, 1991 ) is the only study reported as occurring
in areas with different levels of urbanity. Unfortunately, due to the small
sample size, program site comparisons were not possible. Efforts should be
made to enhance the quantity and quality of multi-site and cross-culture
research, particularly evaluation studies.
Conclusions Return
to TOC
Adolescent sexuality encompasses a wide variety of health issues
that are and should continue to be of concern not only to adolescents,
parents, and family life educators but to all Americans. The rapid increase
in adolescent AIDS cases and the growing number of teens initiating
intercourse at age 14 or younger should not be ignored. Societal discomfort
with sexual issues (including that of parents and adolescents), and fear
that teaching about sexuality and contraception will promote adolescent
sexual activity, have contributed to America's youth not receiving the
education necessary to make informed decisions about sexuality (DHHS, 1995).
It is a disservice to adolescents when educators are unwilling to teach
these issues or when parents and school administrators serve as barriers to
pertinent information.
Fortunately, advances have been made in the knowledge and
literature about adolescent sexuality. For the most part, parenting is
related to adolescent sexuality outcomes via communication, values,
monitoring, and a sense of connection with their teen. However, a lack of
developmental insight is found in this literature. Existing longitudinal
studies tend to start no earlier than early adolescence, focus primarily on
adolescent self-reports, and address a limited number of parent-adolescent
processes, thus making it difficult to test interactions and examine how the
family processes might have differential effects on adolescent sexuality
outcomes.
Despite this gap in the literature, there have been attempts to
strengthen parent-adolescent processes in hopes of promoting healthy
adolescent sexual behavior. To date, a total of 19 adolescent sexuality
programs with a parent component have been located. For the majority of the
programs, evaluation results are promising, however, substantial
contributions remain to be made in this area. Future studies should address
various programming issues including target audiences, degree of parent
participation, and evaluation. In addition, the ecological model (Bronfenbrenner, 1979 ) should be incorporated to a
greater degree in program development and evaluation, including community
level involvement and cross-cultural comparisons.
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Tables Return
to TOC
Table 1 Current Teen Sexuality Programs with a Parent
Component
Table 1 Continued
*
This paper was originally presented at the meeting of Health
Futures of Youth II: Pathways to adolescent health, Department of Health
and Human Services, Annapolis, MD.
**Address correspondence to: Laurie L. Meschke, University of
Minnesota, Division of Epidemiology, 1300 South Second Street, Suite 300,
West Bank Office Building, Minneapolis, MN 55454-1015;E-mail: mailto:%20meschke@epi.umn.edu
Laurie L. Meschke, Ph.D. is the Director of
Community Outreach for the Maternal and Child Health Program in Epidemiology
at the University of Minnesota. Her research focuses primarily on adolescent
sexuality and risk-taking behaviors.
Suzanne Bartholomae, M.S. is a Ph.D.
candidate in Human Development and Family Science at The Ohio State
University. Her interests include basic and applied research related to
economic stress, well-being, and the family, as well as program development
and evaluation.
Shannon Zentall, M.S. completed her Master's
Degree in Human Developmnet and Family Science from The Ohio State
University. She is now a Research Associate at The University of Pittsburgh.
©
2000, National Council on Family
Relations
