A review of interventions with parents to promote the sexual health of their children

How do gender transformative interventions reduce adolescent pregnancy in low- and middle-income countries: a realist synthesis

Background

Adolescent pregnancy poses a significant health challenge for girls aged 15-19 in low- and middle-income countries. While gender transformative interventions (GTIs) aim to address this issue, a substantial research gap exists concerning the underlying mechanisms contributing to their success. This study employs a realist synthesis approach to systematically investigate how, why, for whom, and in what contexts GTIs effectively reduce adolescent pregnancy.

Methods

A five-step realist review examined literature from four databases and five organisational repositories, including published and grey literature. The review focused on GTIs for adolescents aged 10-19 in low- or middle-income countries. Narrative synthesis and realist analysis were used to develop context-mechanism-outcome configurations.

Results

The review analysed 28 documents covering 14 interventions and proposing eight programme theories across three settings. In the school, creating a supportive environment to foster positive social norms and providing a safe space was emphasised. Comprehensive sexual health education to promote critical thinking, knowledge retention, and goal setting was one of the key strategies. Empowering boys to adopt positive gender norms for behaviour change was also identified. In the health facility, providing a safe, supportive, and confidential environment for accessing services, as well as using digital health apps to empower adolescents in sexual reproductive health, were key. In the community, empowering girls through life skills and economic support and involving community members to foster stronger interpersonal bonds and a gender-positive environment were highlighted. These interventions led to increased contraceptive use, delayed marriage, and reduced adolescent pregnancy.

Conclusion

This realist synthesis proposes eight nuanced programme theories of successful GTIs, providing essential insights for developing, implementing, and improving future programmes. These findings offer a foundation for effective strategies to mitigate adolescent pregnancy in diverse socio-cultural contexts.

Registration

PROSPERO: CRD42023398293.

A Black Feminist Study of Black Mother-Daughter Sexual Communication

There is a well-established body of literature on parent-child sexual communication (PCSC) among Black families. Still, most of this work focuses on reducing sexual risk behaviors among Black girls and focuses less on the multidimensionality of PCSC among Black parents and their daughters. In this qualitative study, we explored Black mother-daughter PCSC by analyzing interviews with 29 Black mothers in the U.S. with daughters ages 6-11. We used consensual qualitative research methods to analyze mother's responses to questions about the messages and strategies they used when educating their daughters about sex-related topics, such as pleasure and sexual identity. We identified the following themes related to mothers' goals with their messages: (1) increasing awareness through neutral information, (2) building daughter's sense of self, (3) challenging societal norms and White heteropatriarchy, and (4) upholding societal norms and White heteropatriarchy. We also developed five themes for mother's strategies for PCSC: (5) direct and open PCSC, (6) modeling, (7) integrating real-life examples, (8) centering the child, and (9) monitoring and tailoring daughters' experiences with others. Our findings add to existing research on sex-positive practices among Black families, highlight the need to use critical lenses when exploring PCSC, and have important implications for parent education.

The Impact of Sibling Relationships on Behavioral and Sexual Health among Latino Sexual Minority Men

Pre-exposure prophylaxis (PrEP) is a highly effective method for preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the US initiative. However, there are various barriers that hinder the access and uptake of PrEP among Latino sexual minority men (SMM) at individual, interpersonal, and cultural levels. While the significance of cultural factors in designing and implementing HIV prevention programs for Latino populations has been consistently emphasized in the literature and prioritized by the Centers for Disease Control and Prevention, few studies have directly integrated these cultural factors into their programs. Our study aimed to investigate the potential influence of siblings in promoting the utilization of PrEP for HIV prevention, an area that has received limited attention. We conducted interviews with 31 pairs of siblings between December 2020 and January 2021, which were held in either English or Spanish and lasted approximately 45-60 min. The data were analyzed using a deductive thematic content analysis approach. The interviews revealed several key themes and categories, including: (1) Sibling support for coming out; (2) Types of support that siblings provide to each other for behavior change; (3) Sibling support for PrEP; and (4) The impact of the study interview on the quality of the sibling relationships. Our findings indicated that siblings were willing to provide support for PrEP in various ways, ranging from emotional support for brothers who may be concerned about potential rejection to practical support such as transportation or financial assistance. These results have significant implications for the design of HIV prevention interventions for Latinos. Incorporating siblings or other extended family members into these interventions can facilitate communication between siblings and their brothers, ultimately encouraging the use of PrEP or similar prevention methods. By considering the unique dynamics and support systems within Latino communities, researchers can develop more effective strategies to promote HIV prevention and support the well-being of Latino SMM.

How Parents' Ideals are Offset by Uncertainty and Fears: A Systematic Review of the Experiences of European Parents regarding the Sexual Education of Their Children

Parents have a critical role to play in the sexual education of their children. We conducted a systematic review of studies assessing the experiences of parents regarding the role they play in the sexual education of their children. We included qualitative, quantitative, and mixed methods studies conducted among parents in Europe. We searched PubMed, Web of Science and Scopus, and screened 20,244 unique records. Forty-nine studies enrolling 18,083 unique parents met inclusion criteria. The studies show that parents have ideals regarding the sexual education of their children that center around the importance of trust, open conversations, and honesty. However, challenges and concerns, related to parents' and children's gender, children's age, children's specific situations, and limited parental knowledge and communication skills prevented them from living up to these ideals. Parents pointed to the role of other institutions as ways to support and strengthen parents' contributions to the sexual development of their children. We conclude that parents may require guidance and support to identify what is appropriate sexual education for their children, based on age, gender, and other characteristics, how to provide appropriate sexual education, and to strengthen their sexual communication skills and knowledge of contemporary sexual health issues.

School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT

Background

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.

Objectives

To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.

Design

A cluster randomised trial, incorporating health economics and process evaluations.

Setting

Sixty-six schools across the four nations of the UK.

Participants

Students aged 13-14 years.

Intervention

A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.

Main outcome measures

Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.

Results

The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83).

Limitations

The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).

Conclusions

We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.

Future work

Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.

Trial registration

This trial is registered as ISRCTN10751359.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Encouraging Parental Sexual Communication with Teen Sons: A Social Norms Experiment

Parent-child sexual communication is associated with myriad positive sex-related outcomes for young people, but these conversations tend to be infrequent and limited in scope. Using the Social Norms Approach, we hypothesized that learning that other parents talk with their children about sex-related topics would motivate parents to talk about more sex-related topics with their son. In an online experiment, parents in the United States (N = 378) with a son aged 13-16 were asked how many of 30 sex-related topics they had discussed with their son after exposure to one of the two SNA messages or a control. A 30-day follow-up study repeated these questions. The experiment revealed no significant differences between the three conditions, but all three conditions resulted in greater intentions to discuss more topics with their son in the future. Regardless of condition, parents who identify their sons as gay or bisexual talked about more sex-related topics than parents of sons who identify their sons as straight. The results from this study suggest that social norms messages are not more effective at increasing parents' communication intentions. Parents in all conditions planned to discuss more sex-related topics with their son, suggesting that simply bringing these topics to parents' attention may be enough to increase intentions to have these conversations. Findings are discussed in light of motivating and equipping parents to handle these conversations and tailoring educational materials for parents based on their child's sexual and romantic orientation.

Effectiveness of a School-Based Pregnancy Prevention Intervention for Female Teenagers and Their Boyfriends: A Randomized Controlled Trial

PURPOSE

This study examined the effectiveness of a school-based pregnancy prevention intervention.

METHODS

73 female and male teenagers were recruited from an urban secondary school and randomly assigned to the intervention and control groups. The females were aged 13-15 years, and the boyfriends were aged 13-18 years. The intervention was implemented in six sessions over six weeks. Sessions 1-4 were conducted at the school, and sessions 5-6 were delivered via a smartphone messaging application. The outcomes included sexual health literacy, pregnancy prevention behaviors, and sexual risk behaviors. They were measured three times: at baseline (week 0, T1), immediately post-intervention (week 6, T2), and follow-up (week 10, T3). Two-way mixed repeated measure ANOVA was used to determine the differences of the outcomes.

RESULTS

After completion of the intervention, participants in the intervention group had significantly higher sexual health literacy both at T2 and T3 and better pregnancy prevention behavior. They had lower sexual risk behaviors at T3 than the control group.

DISCUSSION

The results indicate that the school-based pregnancy prevention intervention is effective. It improved the outcomes in female teenagers and their boyfriends at six weeks and 10 weeks post-intervention.

Effectiveness of Psycho-Religious Sexuality Education upon Anger and Depression of Iranian Female Adolescents: The Relationship of Quality Family Relationships and Birth Order

Sexually active adolescents tend to have a wider range of psychosocial problems, including depression, anger, poor academic achievement, low self-esteem, and substance use. Developing a high-quality and curriculum-based comprehensive sexuality education (CSE) program is of great importance for adolescents following Iranian culture. Due to the lack of such an educational program, the purpose of this study was to investigate the effectiveness of psycho-religious CSE upon anger and depression of Iranian female adolescents, as well as the relationship of quality family relationships and birth order. The research design is quasi-experimental with pre-test and post-test with experimental and control groups. The statistical population of this study comprised all Iranian female adolescents aged 15 to 18 years in Mashhad who participated in this workshop voluntarily. For data collection, the Child and Adolescent Depression Inventory and Spielberger's State-Trait Anger Expression Inventory (STAXI) were used. SPSS 21 software and analysis of variance (ANOVA) and covariance (ANCOVA) were used for data analysis. The results showed that there was a significant difference in the mean difference between depression and anger in the control and experimental groups (p-Value < 0.05). The results also showed a significant relationship between birth order and the quality of family relationships on depression and anger. Psycho-religious-based SE can reduce depression and anger in female students. These findings can be used in planning educational interventions with a psycho-religious-based approach to reducing anger, depressive symptoms and dangerous sexual behaviors among adolescents.

Differences in the sexual health information parents/guardians give their adolescent sexual minority sons by outness

Introduction

Parents and guardians are a potentially valuable source of sexual health information for adolescent sexual minority males (ASMM). The current study examines what sexual health topics ASMM report discussing with a parent/guardian and whether topics differ by outness about sexual attraction to other males.

Methods

ASMM (N=154; ages 14-17) in the United States completed the baseline of an online sexual health intervention pilot in 2020. They reported which of twelve sexual health topics they discussed with a parent/guardian and if they had disclosed their sexual attraction to other males. Associations between topics discussed and outness to a parent/guardian were examined with Firth logistic regression.

Results

Eighty-eight (57%) participants reported being out to a parent/guardian. Six sexual health topics were significantly more likely to be discussed if participants were out. The three categories with the largest differences by outness were how to: discuss with a partner what they would not like to do sexually (aOR = 7.0, 95% CI: 2.0-24.6), use condoms (aOR = 5.9, 95% CI: 2.3-15.1), and prevent HIV/AIDS (aOR = 3.5, 95% CI = 1.4-8.7).

Conclusions

Interventions on parental/guardian provision of sexual health information are needed to ensure ASMM receive relevant sexual health knowledge.

Sexual and reproductive health knowledge among adolescent Syrian refugee girls displaced in Lebanon: The role of schooling and parental communication

Adolescent Syrian refugee girls living in Lebanon are vulnerable to poor sexual and reproductive health (SRH). Sociocultural norms, stigmatization, and limited educational opportunities in the context of forced displacement may impact adolescent girls' SRH. Little is known about how and where girls in this population access SRH information and services. This study aimed to: (1) assess knowledge of SRH topics among a population of adolescent Syrian refugee girls displaced in Lebanon, and (2) determine the association of schooling versus maternal SRH communication with SRH knowledge. A total of 418 11-17-year-old Syrian refugee girls displaced in the Beqaa region of Lebanon were recruited to participate in a cross-sectional survey. Bivariate logistic regression and ordinary least squares regression models were used to examine the associations between schooling, maternal SRH communication, and other covariates with SRH knowledge outcomes. Significant predictors (p<0.2) were included in multivariate analyses. The mean age of girls was 13.4 years. Approximately two thirds of our sample was enrolled in school, with enrollment rates dropping considerably around age 15. In bivariate and multivariate models, older age and participation in SRH programs were predictive of puberty knowledge. One in five girls enrolled in school had learned about menstruation in school, which was associated with higher puberty knowledge in bivariate models. Older age, current school enrollment, and reaching the 8th-11th grade were strongly associated with HIV knowledge. Schooling is more strongly associated with SRH knowledge among adolescent girls than is maternal communication. School-based SRH curricula should be administered on the basis of age and not grade, given significant age-for-grade heterogeneity in this population. Forced displacement and poverty are major barriers to education retention and may have long-term impacts on girls' health.

Overcome the Fear (Vencer el Miedo): using entertainment education to impact adolescent sexual and reproductive health and parent-child communication in Mexico

BACKGROUND

Adolescents in Mexico experience high pregnancy and birth rates. A collaboration with Grupo Televisa led to the development of an entertainment-education telenovela intervention, Overcome the Fear (OTF), which aired in 2020 to a national audience and addressed adolescent sexual and reproductive health (SRH) topics. This study details the development and evaluation of OTF's impact on adolescent contraceptive practices and parent-adolescent SRH communication in Mexico.

METHODS

We conducted cross-sectional survey interviews (street-intercept and telephone) with 12-19-year-olds (n = 1640) and parents of adolescent children (n = 820) post-broadcast across Mexico's five most-populated metropolitan zones. Quotas were implemented for gender, zone, and OTF viewership (viewer vs. non-viewer). Bivariate statistics and multivariable binary logistic regression models assessed the relationship between OTF viewership (including parent-adolescent co-viewing) and adolescent contraceptive practices and parent-adolescent SRH communication. Adolescent and parent data are not dyadic and were analyzed separately.

RESULTS

Nearly half of adolescents (47.9%) and parents (47.7%) were viewers. Among adolescents, bivariate analyses suggest that viewers had less negative attitudes towards contraception (p < .001). Logistic regression models suggest that adolescent viewers were more likely to seek out information about contraception (p < .001) and unhealthy romantic relationships (p = .019), and to use contraception other than condoms (p = .027) and dual contraception (p = .042) in the last 3 months. Among parents, bivariate analyses suggest that non-viewers had more positive attitudes towards abstinence (p = .045) and more negative attitudes towards contraception and communication with adolescents about sex (p = .001). Logistic regression models suggest that parent viewers were more likely to have talked with adolescent children about sexual relations (p < .001), contraceptive methods (p = .01), condoms (p = .002), and abstinence (p = .002) in the last 3 months. Parent-adolescent co-viewing of OTF was also significantly related to certain outcomes in bivariate analyses.

CONCLUSIONS

This study suggests that viewership of a high-quality entertainment-education telenovela informed by extensive formative research is related to adolescent health outcomes and to parent-adolescent SRH communication on a country-wide scale in Mexico. Entertainment-education remains an underutilized public health strategy, despite its promise to engage viewers and motivate healthful behaviors.

A Six-Month Outcome Evaluation of Media Aware Parent, a Parent-Based Media Mediation and Sexual Health Communication Program to Promote Adolescent Sexual Health

The purpose of this study was to evaluate the sustained effects of a web-based program for parents of adolescents designed to help them engage in media mediation and high-quality parent-adolescent communication about sex, relationships, and media. A randomized control trial was conducted with parent-adolescent pairs (n=375 pairs). Adolescents were in 7th-9th grade. Pairs were randomly assigned to either the intervention Media Aware Parent or active control (medically accurate adolescent sexual health information). This study analyzed the impact of Media Aware Parent 6 months after pretest. Several outcomes significant at one-month posttest were sustained at 6 months, including enhanced parents' media-related cognitions (e.g. media skepticism) and adolescent awareness of family media rules. Parents' reports of restrictive media mediation and adolescents' reports of their parent engaging in supportive parenting, which were not significant at posttest, emerged as significant at 6 months, signifying that the program resulted in changes in parent behavior and the parent-adolescent relationship over time. The impact of the program on parent-adolescent communication quality and adolescent sexual health and media-related outcomes diminished over time, suggesting the need for program boosters to encourage parents to continue engaging in high-quality conversations with their adolescent children about sex, relationships, and media.

"They will judge you more like a parent instead of like a health practitioner": Perceptions and preferences of young people regarding sexual and reproductive health services in Southwest Nigeria

Adolescents and young people (AYP) experience many barriers in the utilization of sexual and reproductive health (SRH) services. These barriers can be cultural, structural, personal or health worker-related. In this study, we explored the perceptions and preferences of AYP in receiving SRH services at public health facilities in a Nigerian setting. We conducted 16 focus group discussion (FGD) sessions with adolescents and young people allowing for maximum variation by sex (male, female), age (15-19 years and 20-24 years), and marital status (married and unmarried). We applied a thematic framework analysis to explore the data collected. Our findings included both positive and negative attitudes of health workers at public health facilities, non-involvement of AYP in activities relating to the planning, implementation, or evaluation of SRH programs for AYP, and non-awareness among AYP of some of the rights that AYP have with respect to SRH services in public health facilities. Many participants preferred younger health workers or those living within their neighborhood. Some older health workers were said to often act as (strict) parents, not health workers. We conclude that the role ascribed to 'neighborhood' nurses in this study is instructive and deserves more attention. Also, there is a need to increase the awareness of the young people about the type of SRH services they can obtain in the public health facilities, as well as, a need for health workers to be trained and retrained in providing SRH services to AYP.

Mother-daughter communication about puberty in Egypt

Parental communication during puberty can be a protective factor for adolescents. In Egypt, girls have poor access to sexual and reproductive health services and there is a lack of information on puberty in school curricula. Yet little is known about girls' other sources of information about puberty, including communication with mothers. We analysed 29 in-depth interviews with young mothers of girls in Greater Cairo to better understand mother-daughter communication about puberty. We examine respondents' motivations for communication with their daughters, the type of messages they provided or expected to provide, and barriers to mother-daughter communication, paying particular attention to intergenerational dynamics with respect to how women learn about puberty. We found that while mothers wanted to, and did, play a primary role in communicating with girls about puberty, discussions were constrained by lack of information and embarrassment. Mothers were more open to discussing some aspects of puberty, such as hygiene, than others. Conversations may also be delayed due to social norms about what is appropriate for girls to know and when. Messages were often fear-based and embedded in norms that stigmatised girls' sexuality. Programmes and interventions targeting mothers' knowledge and communication skills around puberty should be adapted and tested in the context of Egypt.

Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being

Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.

Parents' Sources of Adolescent Sexual Health Information and Their Interest in Resources From Primary Care

OBJECTIVE

To examine sources of information used by parents to facilitate parent-adolescent communication about sexual and reproductive health (SRH), parents' preferences for receiving SRH information through primary care, and factors associated with parents' interest in primary-care-based SRH information (ie, resources recommended or offered in the primary care setting).

METHODS

In this cross-sectional study, a nationally representative sample of 11-17-year-old adolescents and their parents (n = 1005 dyads) were surveyed online; 993 were retained for these analyses. Parents were asked about their use of 11 resources to help them talk with their adolescents about SRH and rated the likelihood of using specific primary-care-based resources. We used multivariable logistic regression to examine characteristics associated with parent interest in primary-care-based SRH resources.

RESULTS

Only 25.8% of parents reported receiving at least a moderate amount of SRH information from primary care; half (53.3%) reported receiving no SRH information from their adolescent's provider. Parents received the most information from personal connections (eg, spouse/partner, friends). Most parents (59.1%) reported being likely to utilize a primary-care-based resource for SRH information. Parents who previously received SRH information from primary care sources had greater odds of reporting they would be likely to utilize a primary-care-based resources (AOR = 4.06, 95% CI: 2.55-6.46).

CONCLUSIONS

This study provides insights into parents' sources of information for communicating with their adolescents about SRH and ways primary care practices might increase support for parents in having SRH conversations with their adolescents. Future studies are needed to establish clinical best practices for promoting parent-adolescent communication about SRH.

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

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

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.

Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach

The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.

Bridging the Gap between Sexual Health Education and Clinical Services: Adolescent Perspectives and Recommendations

BACKGROUND

Adolescents often lack access to accurate and appropriate sexual health information and services. Providing information about local clinical services during sexual health education classes is one strategy to increase awareness, yet many programs miss this opportunity. This study aims to learn about adolescents' experiences with sexual health education and their perceptions of barriers and facilitators to clinical care.

METHODS

Nine focus groups were conducted between April to July 2018 with 69 adolescents who had recently attended a comprehensive sexual health education program in California. Topics included information received about local clinics during class and barriers and facilitators to access care. Qualitative data were coded and analyzed for key themes and compared by sex and geographic location.

RESULTS

The majority of participants (89%) were Latino and most reported receiving relevant information about clinical services and had positive impressions of local services. Several mentioned that this information increased the likelihood that they would access services if needed. Common barriers to clinic services included parental disapproval, stigma, embarrassment, and confidentiality concerns. Facilitators included peer and family support, confidentiality of services, awareness and education, and accessibility.

CONCLUSIONS

Sexual health education programs can provide an important bridge to local clinic services and address adolescents' concerns.

Development of a child-rearing promotion of sexual abstinence scale (CPSAS) in Thai female adolescents at two Thai universities

Purpose

Child-rearing promoting sexual abstinence has strongly predicted sexual abstinence in Thai female adolescents, and it requires a valid and reliable measurement. However, no such instrument exists. This study aimed to develop a child-rearing promotion of sexual abstinence scale (CPSAS) and assess its validity and reliability.

Design/methodology/approach

The scale development consisted of two phases; scale construction and psychometric testing. Phase I included item generation extracted from a literature review and existing measurements. Items were reviewed by five-panel experts and were then selected by considering an inter-item correlation, corrected item-total correlation, factor loading and communality value from the exploratory factor analysis (n = 299). Phase II involved confirmatory factor analysis (CFA) for construct validity and scale reliability (n = 300).

Findings

The CPSAS, first, contained 25 items with four dimensions; assuring daughter to recognize parental love, teaching daughter sexual abstinence, convincing daughter to recognize parent's expectations of sexual abstinence and encouraging daughter sexual abstinence. Two items were then deleted after the experts reviewed, and six items were removed after item analysis. The CPSAS finally contained 17 items with a 4-point Likert scale. Psychometric testing provided acceptable results. CFA reported the fit indices; χ2 = 98.06 p = 0.083, df = 80, χ2/df ratio = 1.220, CFI = 0.996, TLI = 0.992, RMSEA = 0.027 and SRMR = 0.030. The standardized factor loadings were 0.499 to 0.908 (p < 0.05). The S-CVI was 0.96, and Cronbach's alpha coefficient was 0.93.

Originality/value

The CPSAS is a reliable and valid instrument for evaluating child-rearing promoting sexual abstinence in Thai female adolescents.

Perspectives of Transgender Youth on Parental Support: Qualitative Findings From the Resilience and Transgender Youth Study

Transgender youth are more likely than cisgender youth to report health risks related to violence victimization, substance use, mental health, and sexual health. Parental support may help foster resilience and better health outcomes among this population. However, limited research has characterized parental support among transgender youth. To address this gap, we conducted a thematic analysis of 33 in-depth interviews with transgender youth. We coded interviews using the dimensions of the social support framework (i.e., emotional, instrumental, appraisal, and informational) as well as inductive codes to identify emergent themes. Almost all participants described some form of general parental support (e.g., expressions of love, housing, advice, and affirmation). Parental support specific to gender identity was also noted (e.g., emotional support for coming out as transgender and chosen name and pronoun use) but was more limited. Parents may benefit from resources and programming to promote acceptance and gender-affirming behaviors.

Parent-Adolescent Sex Communication with Sexual and Gender Minority Youth: An Integrated Review

INTRODUCTION

Sexual and gender minority (SGM) youth experience adverse sexual health outcomes at higher rates than their heterosexual and cisgender peers. Although parent-adolescent sex communication (PASC) is associated with improved sexual health outcomes among heterosexual youth, less is known about PASC with SGM youth.

METHODS

Studies describing experiences of SGM youth and parents during PASC and/or health outcomes of PASC were reviewed.

RESULTS

Eleven studies met inclusion criteria, and six themes emerged. These included: (1) limited communication and barriers to communication, (2) impact of SGM disclosure on communication, (3) HIV and/or sexually transmitted disease-focused communication, (4) heteronormative communication, (5) outcomes of communication, and (6) youth preferences for PASC.

DISCUSSION

Parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education and guidance is lacking. This review identifies ways that health providers can foster positive and inclusive PASC.

Engaging parents in digital sexual and reproductive health education: evidence from the JACK trial

BACKGROUND

Research evidence and international policy highlight the central role that parents play in promoting positive sexual behaviour and outcomes in their children, however they can be difficult to engage in sexual and reproductive health (SRH) education programmes. Digital health promotion that uses online and mobile technologies (OMTs) to promote parent-child communication may offer an innovative solution to reach parents, however, few programmes have used OMTs to involve parents in SRH, and none have reported lessons learned in relation to optimising engagement. This study addresses this gap in the literature by reporting acceptability and feasibility of using OMTs to engage parents in SRH education. Findings will be relevant for those wishing to develop and implement digital SRH programmes with parents internationally.

METHODS

The Jack Trial is a UK-wide cluster randomised controlled trial recruiting over 8000 adolescents from 66 socially and religiously diverse post-primary schools. An embedded mixed-methods process evaluation explored user engagement with parent components of the If I Were Jack SRH education programme, which include online animated films and a parent-teen homework exercise.

RESULTS

A total of 109 adolescents, teachers, parents and SRH policy experts took part in semi-structured interviews and focus groups, 134 parents responded to an online survey, and 3179 adolescents completed a programme engagement and satisfaction questionnaire. Parents who accessed the materials were positive about them; 87% rated them as 'good or excellent' and 67% said they helped them have conversations with their child about SRH. Web analytics revealed that 27% of contacted parents accessed the digital materials, with 9% viewing the animated films. Only 38% of teachers implemented the homework exercise, mainly because they assumed that students would not complete it or it might result in backlash from parents.

CONCLUSIONS

While digital parental materials show promise for engaging parents in SRH education, this study suggests that in order to optimise engagement, parental components that give parents the necessary skills to have conversations with their children about sex should be coupled with efforts to increase school and teacher confidence to communicate with parents on sensitive topics.

TRIAL REGISTRATION

ISRCTN99459996 .

Family Sexuality Communication: Parent Report for Autistic Young Adults Versus a Comparison Group

Families are a critical context for healthy sexuality development. This study characterized family sexuality communication for autistic adults (age 18-30) without intellectual disability (n = 117) versus a neurotypical comparison group (n = 319). Parent-reported number of sexuality topics covered did not significantly differ by gender or autism/comparison group. Parents of autistic adults who covered few or no topics (31%) reported higher religiosity, lower comfort and self-efficacy, and were less likely to say that the adult expressed attraction or desire for relationships. Parents of autistic adults were more likely than comparison parents to perceive their young person as being uninterested or not ready to learn about sexuality topics. These results suggest that families of autistic people require support to convey sexuality-related knowledge and values.

Pathways to sexual health communication between adolescent girls and their female caregivers participating in a structured HIV prevention intervention in South Africa

RATIONALE

Interventions that promote sexual health communication between adolescents and their parents or other primary caregivers are an important tool for reducing female adolescents' behavioral risk. Understanding the mechanisms by which interventions effectively foster communication can inform future programs.

OBJECTIVE

An initial evaluation of Let's Talk, a structured, family-centered HIV prevention intervention for vulnerable adolescents in South Africa, found an increase in caregiver-adolescent sexual communication. This analysis expands upon initial findings to explore the role of parental knowledge, the quality of the parent-adolescent relationship, and the mental health of both parties on caregiver-adolescent sexual health communication.

METHOD

Using mixed methods data collected in 2015 and 2016, structural equation modeling of differenced pre- and postintervention survey data from 64 female Let's Talk participants ages 13-17 and their caregivers was used to explore the pathway to increased frequency of caregiver-adolescent sexual health communication. Focus group discussions (FGDs) were held with intervention participants (n = 25) and facilitators (n = 6).

RESULTS

The path analysis indicates that caregivers' mental health indirectly affected caregiver-adolescent relationship quality, and adolescents' mental health exerted a direct effect. Relationship quality, in turn, directly affected the level of parental sexual communication reported by the adolescent. FGDs suggested that cultural norms inhibit frank discussions between caregivers and adolescents about sexual health, but that thoughtfully designed interventions such as Let's Talk can mitigate this barrier. Qualitative findings also echoed quantitative findings about the role of caregiver-adolescent relationship quality and mental health on communication frequency and highlighted the importance of enhancing participants' technical knowledge and particularly their skills related to expression, listening, and anger management to help enable sensitive conversations.

CONCLUSIONS

Findings overall suggest that a holistic intervention approach emphasizing caregiver-adolescent relationship development and designed to support the mental health of both parties may hold significant promise for enhancing sexual health communication.

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

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

Parent - adolescent communication on sexual and reproductive health: the qualitative evidences from parents and students of Addis Ababa, Ethiopia

BACKGROUND

Repeatedly adolescents in Africa have been experiencing early pregnancy by more than 50%, early parenthood by 30% and new HIV infections by more than 80%. Parent - Adolescent communication as an effective strategy on sexual and reproductive health has not been taken up in most of African countries including Ethiopia. The aim of the study was to assess the challenges of Parent - Adolescent communication on sexual and reproductive health practices in Addis Ababa, Ethiopia.

METHODS

A qualitative cross-sectional study exploring Parent - Adolescent communication practices was conducted in two high schools Yeka sub-city, Addis Ababa, Ethiopia. Students aged 15-19 years were recruited for in-depth interviews and focused group discussions (FGD) as well as respective parents for in-depth interviews and parents' FGD.

RESULTS

Twenty students were available for in-depth interviews and all of them for FDG. Sixteen parents were available for in-depth interviews and nine of them for parent's FGD. Parent - Adolescent communication on sexual and reproductive was reported to be important by both adolescents and parents. The parental initiation is rare. The initial sexual activity by the adolescents triggers initiation by parents. The communications are gender dependent, not planned and not continuous and inhibited by intergenerational cultural taboo. A gap exists in parental knowledge on such communications. Parents deny responsibilities to communicate with adolescent as they fear it will perpetuate early sex practices, adolescents are too young it's an embarrassment, often being busy for household income retards their wills to communicate.

CONCLUSIONS

Parent-Adolescent communications on sexual and reproductive health is not a common practice in Addis Ababa, Ethiopia due to taboo, cultural structures, gender domains and parental knowledge. These findings alarm the risk of adolescent exposure towards unwanted pregnancies, transmissions of HIV/AIDS and Sexually Transmitted Infections in Addis Ababa.

Beyond the talking imperative: The value of silence on sexuality in youth-parent relations in Bangladesh

Research conducted in various parts of the globe suggests that young people who can openly communicate with their parents about sexuality benefit in many ways. Correspondingly, in Bangladesh, the lack of an open communication on sexuality in the youth-parent relationship is considered a barrier to ensuring young people's sexual and reproductive health and overall well-being. Taking 'silence' as a core concept, this paper investigates what silence on sexuality means to Bangladeshi young people in their relationship with parents. It draws on findings from an ethnographic study conducted among 72 middle-class boys and girls aged between 15 and 19 years and 18 parents living in Dhaka over a year between 2016 and 2017. The findings suggest that silence is not always perceived as problematic by young people, and this is particularly true for topics related to sexual pleasure. This paper challenges the monolithic understanding that silence is necessarily bad and hinders young people from getting what they need. It offers an additional conceptual understanding to silence for studying sexuality among youths and designing interventions for their sexual and reproductive well-being.

Effectiveness of Sex Education Interventions in Adolescents: An Overview

The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

ACOG Committee Opinion No. 758: Promoting Healthy Relationships in Adolescents

Obstetrician-gynecologists have the opportunity to promote healthy relationships by encouraging adolescents to discuss past and present relationships while educating them about respect for themselves and mutual respect for others. Because middle school is a time when some adolescents may develop their first romantic or sexual relationships, it is an ideal timeframe for obstetrician-gynecologists and other health care providers, parents, and guardians to play a role in anticipatory guidance. Creating a nonjudgmental environment and educating staff on the unique concerns of adolescents are helpful ways to provide effective and appropriate care to this group of patients. Obstetrician-gynecologists and other health care providers caring for minors should be aware of federal and state laws that affect confidentiality. Obstetrician-gynecologists should screen patients routinely for intimate partner violence along with reproductive and sexual coercion and be prepared to address positive responses. Furthermore, obstetrician-gynecologists should be aware of mandatory reporting laws in their state when intimate partner violence, adolescent dating violence, or statutory rape is suspected. Pregnant and parenting adolescents; lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) individuals; and adolescents with physical and mental disabilities are at particular risk of disparities in the health care system. The promotion of healthy relationships in these groups requires the obstetrician-gynecologist to be aware of the unique barriers and hurdles to sexual and nonsexual expression, as well as to health care. Interventions to promote healthy relationships and a strong sexual health framework are more effective when started early and can affect indicators of long-term individual health and public health.

Adult and young women communication on sexuality: a pilot intervention in Maputo-Mozambique

BACKGROUND

Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into account that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context.

METHODS

The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions.

RESULT

The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex.

CONCLUSION

By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality.

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

IMPORTANCE

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION AND SYNTHESIS

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

MAIN OUTCOMES AND MEASURES

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

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

Evaluating the Short-term Impact of Media Aware Parent, a Web-based Program for Parents with the Goal of Adolescent Sexual Health Promotion

Parents can significantly impact their adolescent child's sexual and relationship decision-making, yet many parents are not effectively communicating with their teens about these topics. Media are sexual socialization agents for adolescents, which can encourage early or risky sexual activity. Media Aware Parent is a web-based program for parents of adolescents that was designed to improve adolescent sexual health by providing parents with the skills to have high-quality communication with their child about sex and relationships as well as to mediate their media usage. This web-based randomized controlled trial was conducted in 2018-2019 with parent-child pairs (grades 7, 8, or 9; N = 355) from across the United States. Parent participants identified as mostly female (75%), white/Caucasian (74%); and non-Hispanic (92%). The youth sample was more balanced in terms of gender (45% female) and more diverse with respect to race (66% white) and ethnicity (86% non-Hispanic). Twenty-eight percent of the families identified as a single parent household, and 35% of the youth were eligible for free school lunch. The present study assessed the short-term effects of Media Aware Parent on parent-adolescent communication, adolescent sexual health outcomes, and media-related outcomes across a one-month timeframe. Parents were randomly assigned to the intervention (Media Aware Parent) or active control group (online access to medically-accurate information on adolescent sexual health). The intervention improved parent-adolescent communication quality as rated by both parents and youth. Youth were more likely to understand that their parent did not want them to have sex at this early age. Youth reported more agency over hook-ups, more positive attitudes about sexual health communication and contraception/protection, and more self-efficacy to use contraception/protection, if they decide to have sexual activity. The intervention improved media literacy skills in both parents and youth, and resulted in youth being more aware of family media rules. Parents gave overwhelming positive feedback about Media Aware Parent. The results from this pretest-posttest study provide evidence that Media Aware Parent is an effective web-based program for parents seeking to enhance parent-adolescent communication and media mediation, and positively impact their adolescents' sexual health outcomes.

Longitudinal trajectories of perpetration of adolescent dating abuse in a national sample

Despite extensive research regarding patterns and outcomes of victimization in dating relationships, there has been limited investigation of the developmental profiles of the perpetration of adolescent dating abuse (ADA). We estimated longitudinal latent growth models of ADA perpetration in a sample of 2,269 U.S. adolescents/young adults ages 12-18 at baseline, drawing on four waves (2013-2017) of data from the nationally representative Survey of Teen Relationships and Intimate Violence. Model results revealed three classes representing "nondaters," respondents showing "increasing dating/ADA," and respondents with "high/stable dating/ADA." Results support prior research finding heightened patterns of ADA perpetration by older youth, and distinguish individual and family characteristics associated with adolescent/young adults' ADA perpetration for the purpose of informing individual and programmatic prevention efforts.

Couple Relationship and Parent-Child Relationship Quality: Factors Relevant to Parent-Child Communication on Sexuality in Romania

This study of parents in Romania explores how perceptions of their couple relationship quality and of factors associated with it (such as sexual communication anxiety and sexual perfectionism) were related to their perception of aspects describing parenting dimensions relevant to the sexual education and sexual health of their children. The hypotheses tested in this study were supported by the data collected from 106 participants (aged 25 to 51 years), parents of 1 to 3 children: (1) sexual communication anxiety with one’s partner (but not sexual perfectionism) is a significant predictor for parents’ self-efficacy, outcome expectancy and communication and parenting behavior related to sexuality education; (2) parents’ self-efficacy and outcome expectancy about parent-child communication on sexual topics (including involvement in risky sexual behaviors) predict the level of parenting behavior in this respect; (3) parents’ sexual communication anxiety (but not their sexual perfectionism) together with their self-efficacy and outcome expectancy regarding parent-child communication about sexuality predict the level of parental sexuality-communication-and-education behavior.

Parent-Teen Communication about Sexual and Reproductive Health: Cohort Differences by Race/Ethnicity and Nativity

Parent-teen discussions about sexual and reproductive health (SRH) are associated with delayed sex and higher contraceptive use among teens. Using the National Survey of Family Growth, we conducted bivariate and multivariate analyses of different types of parent-teen SRH discussions among two cohorts of teens. We describe differences in patterns for males and females by race/ethnicity and nativity, and test for racial/ethnic interactions within each cohort. Analyses found that the prevalence of parent-teen discussions about SRH increased across cohorts. For males and females, there were increases in parent-teen discussions about condoms, and for males only, there were increases in any SRH discussions and discussions about contraception and STIs. Based on interactions, parent-teen discussions and STI discussions increased most for Hispanic females, and among Hispanics, increased most for the foreign-born. These data indicate increases in different types of parent-teen SRH discussions, particularly for males and foreign-born teens overall, and for Hispanic teen females regarding condom use. Future research should examine what factors are driving these changes, including changes in the structure of U.S. Hispanic communities and expansion of evidence-based teen pregnancy prevention programs.

The Influence of Families on LGBTQ Youth Health: A Call to Action for Innovation in Research and Intervention Development

Lesbian, gay, bisexual, transgender, queer, questioning, and other sexual and gender minority youth (LGBTQ) experience myriad health inequities relative to their cisgender heterosexual peers. Families have a profound impact on adolescent health, but little is known about this influence on LGBTQ youth specifically. We draw on work presented at a public symposium that aimed to characterize existing scientific evidence, identify gaps in knowledge, and set priority areas for future research on the influence of family factors on LGBTQ youth health. We review the evidence in each identified priority area and propose promising avenues for future research and opportunities for innovation.

Reproductive Health for Teens: Parents Want In Too

A mixed method approach explored teens' preferred source of information on sex and reproductive health. Parents' concerns about and perceived barriers to providing reproductive health information to their teens were also explored. Data were gathered from an online survey of 347 teens and three focus groups comprising parents of teens from three Massachusetts communities. Most teens expressed their desire for parents to be one of their primary sources of information (85%). Most parents believed that sexual education should start at home, yet many have not communicated such information. Parents expressed difficulty in staying up-to-date and felt uncomfortable communicating with their teens. Parent perception of supporting factors included a good parent-child relationship and beginning the discussions at a young age. There is a need for culturally sensitive and innovative interventions aimed at creating a safe place for parents to gain knowledge, resources, and strategies to talk to their teens about sex and reproductive health.

Testing the Efficacy of a Web-Based Parent-Adolescent Sexual Communication Intervention Among Puerto Ricans

This randomized controlled trial tested the efficacy of a Web-based intervention to increase sexual communication between parents and adolescents. Parent/adolescent dyads (n = 660) were recruited from communities in the San Juan area and randomly assigned to the Cuídalos sexual communication or physical activity program. Parent assessments were obtained preintervention and at 3-, 6-, and 12-month follow-up. Parents in the experimental group reported significantly more sexual communication (ie, peer pressure, sexual prevention, protection, risk) over time than parents in the control group. Results support the efficacy of the Cuídalos Web-based format and provide insight into future Web-based sexual health interventions for this population.

Effects of a School-Based Intervention on Frequency and Quality of Adolescent-Parent/Caregiver Sexuality Communication: Results from a Randomized-Controlled Trial in Uganda

In a cluster-randomized trial conducted in 22 government secondary schools in Uganda, effects of a school-based intervention aimed at improving aspects of parent/caregiver-adolescent communication on sexuality were examined. The intervention comprised classroom-based education sessions, take home assignments for students to discuss with parents/caregivers and parenting workshops. Baseline and post intervention questionnaires were completed by students and by parents/caregivers. Effect estimates were significant for both students and parents/caregivers on sexuality communication frequency and quality, and for positive and negative attitudes towards sex-related communication, all in the desired direction with effect sizes ranging from 0.17 to 0.38. Effects on four sum scores related to general parenting proved significant only for parents'/caregivers' legitimacy with regard to rule setting (parents'/caregivers' reports only). These results suggest that in Uganda, using schools as gateways, parent/caregiver-adolescent communication can be improved through modification of existing school curricula, training teachers in learner-centred approaches and through mobilization and training of parents/caregivers.

Father-Son Communication About Consistent and Correct Condom Use

: media-1vid15852345835001PEDS-VA_2018-1609Video Abstract OBJECTIVES: With this study, we explore communication about consistent and correct condom use among African American and Latino male adolescents ages 15 to 19 and their fathers.

METHODS

Twenty-five father-son dyads completed semistructured interviews designed to elicit specific preferences for teaching and learning about consistent and correct condom use and strategies for addressing common condom use errors and problems. For analysis, we used in vivo coding and vertical and horizontal analysis techniques.

RESULTS

Fathers and sons agreed that communication about condom use is feasible and acceptable. However, fathers tended to convey vague messages regarding protecting oneself from the negative consequences of sexual activity. Furthermore, both fathers and sons reported barriers hindering conversations. Secondly, the style and frequency of condom use conversations can help overcome barriers and support father-son relationship management. Talking frequently in 1-on-1 settings and using strategies to reduce discomfort made communication easier. Lastly, fathers and sons reported distinct preferences for teaching and learning about condom use. Sons wanted fathers to give specific guidance on the use and management of condoms. Fathers expressed interest in opportunities for improving their own condom knowledge and skills. Fathers identified gaps in their own condom use knowledge as a limitation to effective instruction of their sons.

CONCLUSIONS

A father-focused communication intervention about condom use is feasible and acceptable. Enhancing the intergenerational benefits of father-son communication by addressing specific father-son preferences and learning needs for condom use instruction, as well as communication barriers, represents a novel mechanism for reducing male sexual reproductive health disparities.

Barriers between mothers and their adolescent daughters with regards to sexual and reproductive health communication in Taunggyi Township, Myanmar: What factors play important roles?

BACKGROUND

Parents play critical roles in adolescents' sexual and reproductive health (SRH) and discussions between parents and adolescents on this topic are fundamental in reducing adolescents' risky sexual behaviors. However, SRH communication is a challenging issue in Myanmar due to socio-cultural taboos. This study assessed the communication barriers towards SRH issues among mothers and their adolescent girls.

METHODS

A community-based, cross-sectional study was conducted from January to December 2017 in Taunggyi Township, Southern Shan State, Myanmar. In total, 112 pairs of mothers and adolescent daughters were recruited using a face-to-face interview method with semi-structured questionnaires. Logistic regression analysis was applied to examine communication barriers on SRH issues between mothers and their adolescent girls.

RESULTS

More than half of both mother and adolescent girls had negative perceptions of communication on SRH issues. Only 2.7% of girls discussed SRH issues with their mothers more than four times in the last six months. The factors found to create SRH communication barriers were higher family incomes (adjusted odd ration [AOR] 2.5, 95% confidence interval [CI] 1.0, 6.2), good knowledge of puberty (AOR 4.5, 95% CI 1.6, 12.5), good knowledge of sexual and reproductive health issues (AOR 4.5, 95% CI 1.8, 11.5), and positive perception of communication (AOR 6.7, 95% CI 2.5, 17.9) among mothers, and good knowledge of contraception (AOR 5.7, 95% CI 1.5, 21.4) and good knowledge of sexually transmitted infections (AOR 2.5, 95% CI 1.0, 6.4) among adolescent girls.

CONCLUSION

Mothers and adolescent girls communicated on SRHs was narrow, occurring infrequently and late, with only limited topics discussed. Having higher levels of SRH knowledge were more likely to create communication barriers among mother and adolescent girls. Policy makers need to consider targeted sexual and reproductive health education programs that can be implemented at the school and community levels to increase parent-adolescent communication.

The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women

In sub-Saharan Africa, adolescent girls and young women (AGYW) are 5 to 14 times more likely to be infected with HIV than their male peers. Every day, more than 750 AGYW are infected with HIV. Many factors make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The President's Emergency Plan for AIDS Relief (PEPFAR) is dedicating significant resources through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) partnership to impact the lives of women and girls based on PEPFAR's mission to help countries achieve epidemic control of HIV/AIDS. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control. With support from PEPFAR and private sector partners-the Bill & Melinda Gates Foundation, Gilead Sciences, Girl Effect, Johnson & Johnson and ViiV Healthcare, DREAMS works together with partner governments to deliver a core package of interventions that combines evidence-based approaches that go beyond the health sector, addressing the structural drivers that directly and indirectly increase girls' HIV risk. Not only is DREAMS an effort to reduce new HIV infections, but it aims to reduce other critical vulnerabilities such as gender-based violence. When girls and young women thrive, the effects are felt throughout their families, communities and countries.