Quality of parent communication about sex and its relationship to risky sexual behavior among youth in psychiatric care: a pilot study

Impact of Family, Neighborhood, and Schools on Behavioral Health Needs of Justice-Involved Latinx Adolescents

Latinx adolescents are overrepresented in the justice system and have high untreated behavioral health needs. We examined the family as well as promotive and inhibitive environments (i.e., neighborhood and school) and their associations on behavioral health among 181 first-time justice-involved Latinx adolescents. Results showed that more optimal caregiver-adolescent attachment was associated with fewer behavioral health needs; more negative caregiver-adolescent communication with greater behavioral health needs. Increased neighborhood disadvantage and negative school interactions served as inhibitive environments and were associated with greater behavioral health needs. Moderation analyses indicated that negative communication was associated with greater behavioral health needs among dyads with large acculturation differences but not for dyads close in acculturation. Findings underscore the need to assess the family relationships and communication, promotive/inhibitive environments, and acculturation differences when determining how to meet behavioral health needs among justice-involved Latinx adolescents.

Maternal Communication About Sexual Content and Ease of Access to Contraceptives

Previous literature has emphasized the role of mothers in sexual health communication with their adolescents. However, the extant literature lacks exploration of the importance of parental communication in association to specific risk-reduction behaviors, such as access to contraceptives. Therefore, the purpose of the current study was to explore the roles of parental attachment, the mother-daughter relationship, and communication about sexual content during adolescence in relation to women's recalled access to contraceptives during their teen years. Cisgender female participants aged between 18 and 35 (N = 582) were retrospectively assessed on maternal and paternal attachment, the mother-daughter relationship, mother-daughter communication about sexual content, and their own access to contraceptives during their teen years. After controlling for socioeconomic status, participant race, and history of pregnancy, only maternal communication about sexual content significantly related to access to contraceptives and ease of access to contraceptives. These results demonstrated that specific communication about sexual content was associated with greater access and ease of access to contraceptives, whereas more general relationship factors and communication did not.

Open trial of the Parent Behavior Change Intervention (PBC-I): Study protocol

OBJECTIVE

Parents have profound impacts on adolescents' health behaviors. Yet parents receive minimal training in the elements of conversations that optimally inspire their children toward engaging in healthy behaviors. The current study examines a novel interpersonal target: parent-adolescent conversations about adolescent health behavior change. Derived from advances in the science of behavior change, the Parent Behavior Change Intervention (PBC-I) contains conversational elements (e.g., behavior change techniques, positive communication strategies) hypothesized to reduce parent-adolescent coercion and conflict and facilitate upward spirals of healthy behavior change in adolescents.

METHOD/DESIGN

The first phase of the study involves the development of the PBC-I in a small case series (N = 12 dyads). The second phase involves an open trial of the PBC-I (N = 36 dyads). Adolescents will receive six 50-min sessions of the Transdiagnostic Sleep and Circadian Intervention to improve sleep while their parents receive six50-min sessions of the PBC-I. Parent-adolescent dyads will be assessed before and after the intervention. The primary analysis will examine whether postintervention use of behavior change techniques and positive communication strategies by parents is higher than preintervention use and whether increased use by parents predicts more positive conversational behaviors, less parent-adolescent conflict, higher adolescent motivation for change, and improved adolescent sleep.

DISCUSSION

This research provides an initial test of the hypothesis that improving the parent-adolescent conversation will improve adolescent sleep health behavior. While sleep-related health behaviors are the focus of this study, the research is designed to be relevant to a broad range of health behavior change in young people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior

Background

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM.

Purpose

The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM.

Method

YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling.

Results

Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior.

Conclusions

Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.

Adolescents' compulsive sexual behavior: The role of parental competence, parents' psychopathology, and quality of parent-child communication about sex

BACKGROUND AND AIMS

Compulsive sexual behavior (CSB) has implications for clinical and non-clinical adult populations. Disposition to CSB has been shown to influence adolescence sexual behaviors, but the development of adolescents' disposition toward CSB has yet to be examined in the family context. In this study, we investigated whether parent-adolescent communication mediates the links between parental characteristics and adolescents' CSB.

METHODS

The sample included 275 Israeli families [triad of mothers (age = 34-63 years, M = 45.48, SD = 5.46), fathers (age = 36-83 years, M = 48.33, SD = 6.63), and one adolescent (48.2% boys, 51.1% girls; age = 14-18 years, M = 16.23, SD = 1.18)]. Parents completed measures of psychopathology, parental self-esteem, and parental self-efficacy, and adolescents completed measures of quality of sex-related communication and CSB.

RESULTS

The results indicate that, for girls, higher maternal self-esteem and lower psychopathology were linked with better sex-related communication and so with lower CSB. For boys, only parental religiosity was linked with the quality of sex-related communication and CSB, with religious parents having better communication than secular ones.

DISCUSSION

The findings provide an opportunity for researchers to gain a better insight into the dynamics of familial factors in the development of CSB among adolescents.

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

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

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

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

Evaluating the parent-adolescent communication toolkit: Usability and preliminary content effectiveness of an online intervention

Aim

This study aimed to assess the Parent-Adolescent Communication Toolkit, an online intervention designed to help improve parent communication with their adolescents. Participant preferences for two module delivery systems (sequential and unrestricted module access) were identified.

Design

Usability assessment of the PACT intervention was completed using pre-test and posttest comparisons. Usability data, including participant completion and satisfaction ratings were examined.

Methods

Parents (N = 18) of adolescents were randomized to a sequential or unrestricted chapter access group. Parent participants completed pre-test measures, the PACT intervention and posttest measures. Participants provided feedback for the intervention to improve modules and provided usability ratings. Adolescent pre- and posttest ratings were evaluated.

Results

Usability ratings were high and parent feedback was positive. The sequential module access groups rated the intervention content higher and completed more content than the unrestricted chapter access group, indicating support for the sequential access design. Parent mean posttest communication scores were significantly higher (p < .05) than pre-test scores. No significant differences were detected for adolescent participants. Findings suggest that the Parent-Adolescent Communication Toolkit has potential to improve parent-adolescent communication but further effectiveness assessment is required.

Understanding the relationship between religiosity and caregiver-adolescent communication about sex within African-American families

Caregiver-adolescent communication about sex plays a critical role in the sexual socialization of youth. Many caregivers, however, do not engage their youth in such conversations, potentially placing them at risk for negative sexual health outcomes. Lack of caregiver-adolescent communication about sex may be particularly harmful for rural African American youth, as they often report early sex initiation and are disproportionately impacted by STIs. Moreover, sexual communication may be particularly challenging for families with strong religious backgrounds, potentially affecting the occurrence and breadth of topics covered during communication. Study aims were to: determine whether there was a relationship between caregiver religiosity and type of topics covered during communication about sex (e.g., general sexual health vs. positive aspects of sexuality) among 435 caregivers of early adolescent, African American youth; and if so, identify factors that might explain how religiosity affects communication about sex. Results indicated that caregiver religiosity was positively associated with communication about general, but not positive aspects of sexuality for caregivers of males. Attitudes towards communication about sex and open communication style mediated the relationship. There was no association between religiosity and communication about sex for caregivers of females. The findings from this study could provide a base to better understand and support the sexual socialization process within religious, African American families.

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

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

Contextual Factors and Sexual Risk Behaviors Among Young, Black Men

Young Black men (YBM), aged 13 to 24 years, face a disproportionate burden of sexually transmitted infections (STIs). STI acquisition among YBM is due to incorrect and inconsistent condom use and is exacerbated by multiple sexual partners. Sexual and reproductive health is influenced by a complex interaction of biological, psychological, and social determinants that contribute to increased risk for STI acquisition. However, there are key social determinants of sexual health that play a major role in adolescent sexual risk-taking behaviors: gender norms, environment, peers, and families as well as a desire to impregnate a woman. Associations between contextual factors (risky environmental context, desire to impregnate a woman, and peer norms supportive of unsafe sex) and sexual risk behaviors were examined among a sample of YBM attending adolescent health clinics. This study used baseline data from a randomized controlled trial ( N = 702). Parental monitoring was also examined as an effect modifier of those associations. Sexual risk behaviors were the frequency of condomless vaginal sex, number of sexual partners within the previous 2 months, and lifetime number of sexual partners. Mean age was 19.7. In the adjusted model, peer norms was the only significant predictor for all sexual risk outcomes ( p < .05). Parental monitoring was an effect modifier for the perceived peer norms and lifetime sexual partners association ( p = .053) where the effect of peer norms on lifetime sexual partners was lower for participants with higher levels of perceived parental monitoring.

What Parents and Their Gay and Bisexual Sons Say About HIV Prevention

Despite ongoing prevention efforts, young gay and bisexual men (YGBM) accounted for more than three fourths of all recent HIV infections. Furthermore, they continue to engage in high-risk sexual behaviors at alarming rates. Nowadays, families are beginning to emerge as important resources for these youth. However, the viewpoints of YGBM and their families are largely missing from HIV prevention research and intervention development. To address this gap, we solicited the opinions of YGBM and their parents as to why YGBM engage in unsafe sex and what might be done to help them avoid HIV. Participants discussed youth's sense of invulnerability, sexual arousal, parental disapproval, and lack of societal acceptance as contributors to unsafe sex. Participants called for gay-sensitive sex education and community programming as well as increased societal acceptance. Overall, respondents recommended interpersonal and structural-level interventions that emphasized the importance of reducing stigma as a key component of HIV prevention.

Task-Specific Balance Training Improves the Sensory Organisation of Balance Control in Children with Developmental Coordination Disorder: A Randomised Controlled Trial

Sensory organisation of balance control is compromised in children with developmental coordination disorder (DCD). A randomised controlled trial involving 88 children with DCD was conducted to evaluate the efficacy of a task-specific balance training (functional-movement training, FMT) programme in improving balance deficits in a DCD population. The DCD participants were randomly assigned to either a FMT group or a control group. The FMT group received two training sessions/ week for 3 months. Measurements of the participants' sensory organisation (somatosensory, vestibular and visual ratios), balance and motor proficiency (Movement Assessment Battery for Children, MABC scores) and center of pressure sway velocity (Unilateral Stance Test, UST scores) were taken at baseline, immediately after FMT and 3 months after FMT. The FMT group showed greater improvements than the controls in somatosensory ratio at 3 and 6 months (all P < 0.001), but the within-group changes were not significant (P > 0.05). The results of both the MABC and the UST also indicated that the balance performance of the FMT group was significantly better than that of the control group at 3 and 6 months (all P < 0.05). Task-specific balance training was found to marginally improve the somatosensory function and somewhat improve the balance performance of children with DCD.

Solution-Focused Strategies for Effective Sexual Health Communication among African American Parents and Their Adolescents

The high rates of sexual risk behaviors, particularly among African American youths who may not be aware of their HIV status, provide indication that, unless prevention efforts are enhanced, this vulnerable group of youths will remain at greater risk for negative health status outcomes. Parents are important in efforts to reduce risk among youths and often have a willingness to be sexuality educators for their children; however, communication barriers often impede their ability to provide preventive sexual health knowledge to their youths. Social workers are often presented with opportunities to help parents develop effective sexual health communication skills in informal settings when formal interventions are not feasible. The present effort considers solution-focused strategies social workers can use to help parents overcome barriers and communicate more positively with their youths about sexual health.

A Question of Love and Trust? The Role of Relationship Factors in Adolescent Sexual Decision Making

OBJECTIVE

While representing only 25% of the sexually active population, 50% of all new sexually transmitted infections occur among young people mostly because of inconsistent condom use. Critically, the majority of adolescent sexual activity takes place in the context of romantic relationships; thus, it is important to understand how relationship factors may influence decision making about the use of protection.

METHODS

We used a mixed-method approach to investigate the extent to which relationship length, degree of trust or love in the relationship, and frequency of intercourse influence both perceptions of the probability of condom use and self-reported condom use in the context of relationships among a diverse sample of high-risk adolescents (age 12-19 yr).

RESULTS

Participants were least likely to use condoms if they were in relationships with high trust or love and high frequency of intercourse. Importantly, sexual experience status was a strong moderator of primary effects.

CONCLUSION

The perspective of motivated cognition provides a useful theoretical framework to better understand adolescent decision making about condom use, particularly for sexually experienced youth.

The role of romantic attachment security and dating identity exploration in understanding adolescents' sexual attitudes and cumulative sexual risk-taking

This study addressed how two normative developmental factors, attachment and identity, are associated with adolescents' sexual attitudes and sexual risk-taking behavior. The sample consisted of 2029 adolescents (mean age = 16.2 years) living in the Southeast United States. Path analysis was used to test the hypotheses. Higher levels of attachment anxiety predicted more dating identity exploration and less healthy sexual attitudes. Higher levels of attachment avoidance predicted less dating identity exploration and indirectly predicted less healthy sexual attitudes through dating identity exploration. Females with dating or sexual experience showed the weakest associations between the attachment dimensions and dating identity exploration. More dating identity exploration predicted healthier sexual attitudes; this association was strongest for non-virgins. Finally, higher levels of attachment avoidance were associated with higher cumulative sexual risk scores, but only among non-virgin males. Results are interpreted in light of theory and research on attachment, identity exploration, and adolescent sexual relationships.

Parental monitoring, parent-adolescent communication about sex, and sexual risk among young men who have sex with men

Parental monitoring and parent-adolescent communication about sex protect against HIV-related sexual risk behaviors among heterosexual adolescents, but it is unknown if these findings generalize to young men who have sex with men (YMSM). Sexual orientation-specific stressors, including "coming out" to parents, complicate the family context of YMSM. We examined associations between parental monitoring, communication about sex, outness to cohabitating parents, and sexual behaviors. Ethnically diverse YMSM ages 14-19 provided cross-sectional data (n = 257). Monitoring and outness to parents interacted to predict recent same-sex unprotected anal intercourse (UAI). For YMSM who reported mixed or uncertain outness to parents, higher levels of perceived parental monitoring were associated with greater risk of UAI. Higher levels of communication about sex were associated with greater risk of UAI for YMSM out to parents. Parental monitoring and communication about sex might not protect YMSM against sexual risk in the same way they protect heterosexual youth. Future research should examine whether adapted forms of family factors could protect YMSM, and family-based HIV risk-reduction interventions for YMSM should be attuned to the unique ways family factors function within this group.

Gender-specific relationships between depressive symptoms, marijuana use, parental communication and risky sexual behavior in adolescence

A large body of research has identified correlates of risky sexual behavior, with depressive symptoms and marijuana use among the most consistent psychosocial predictors of sexual risk. However, substantially less research has examined the relationship between these risk variables and adolescent risky sexual behavior over time as well as the interaction of these individual-level predictors with family-level variables such as parenting factors. Additionally, most studies have been restricted to one index of risky sexual behavior, have not taken into account the complex role of gender, and have not controlled for several of the factors that independently confer risk for risky sexual behavior. Therefore, the current study investigated the association between depressive symptoms and parameters of parenting on marijuana use, number of sexual partners and condom usage measured 9 months later for both boys and girls. Participants were 9th and 10th grade adolescents (N = 1,145; 57.7% female). We found that depressive symptoms may be a gender-specific risk factor for certain indices of risky sexual behavior. For boys only, marijuana use at Time 2 accounted for the variance in the relationship between depressive symptoms at Time 1 and number of partners at Time 2. Additionally, strictness of family rules at Time 1 was associated with the number of partners with whom girls engaged in sex at Time 2, but only among those with lower levels of depressive symptoms at Time 1. Results from the current investigation speak to the utility of examining the complex, gender-specific pathways to sexual risk in adolescents. Findings suggest that treatment of mental health and substance use problems may have important implications in rates of risky sexual behavior and, conceivably, controlling the high rates of serious individual and public health repercussions.

Multi-level factors associated with pregnancy among urban adolescent women seeking psychological services

The purpose of this study was to examine the prevalence of pregnancy as well as multi-level factors (i.e., individual, family, and environment) associated with history of pregnancy among a sample of urban adolescent women seeking psychological services. Data were collected from a total of 264 sexually active, 13-18-year-old, adolescent women who participated in a larger HIV prevention study. Adolescents and one participating parent completed an audio computer-assisted self-interviewing survey. A total of 17.4% of participants reported a history of pregnancy. A multivariable logistic regression model suggests that after controlling for empirically derived sociodemographic and behavioral covariates, absence of father in the home, family support and cohesion, and neighborhood risk were positively related to pregnancy. This study is among the first to examine multi-level factors associated with pregnancy among adolescent women diagnosed with psychological disorders. Consideration of such factors is crucial both in terms of clinical practice and in the design of pregnancy prevention programs. Collaboration between physicians and mental health providers working with adolescent women is crucial and represents an ideal opportunity to promote parental involvement and access to supportive community resources, including pregnancy prevention programs for this vulnerable population of adolescents.

Gender-specific relationships between depressive symptoms, marijuana use, parental communication and risky sexual behavior in adolescence

A large body of research has identified correlates of risky sexual behavior, with depressive symptoms and marijuana use among the most consistent psychosocial predictors of sexual risk. However, substantially less research has examined the relationship between these risk variables and adolescent risky sexual behavior over time as well as the interaction of these individual-level predictors with family-level variables such as parenting factors. Additionally, most studies have been restricted to one index of risky sexual behavior, have not taken into account the complex role of gender, and have not controlled for several of the factors that independently confer risk for risky sexual behavior. Therefore, the current study investigated the association between depressive symptoms and parameters of parenting on marijuana use, number of sexual partners and condom usage measured 9 months later for both boys and girls. Participants were 9th and 10th grade adolescents (N = 1,145; 57.7% female). We found that depressive symptoms may be a gender-specific risk factor for certain indices of risky sexual behavior. For boys only, marijuana use at Time 2 accounted for the variance in the relationship between depressive symptoms at Time 1 and number of partners at Time 2. Additionally, strictness of family rules at Time 1 was associated with the number of partners with whom girls engaged in sex at Time 2, but only among those with lower levels of depressive symptoms at Time 1. Results from the current investigation speak to the utility of examining the complex, gender-specific pathways to sexual risk in adolescents. Findings suggest that treatment of mental health and substance use problems may have important implications in rates of risky sexual behavior and, conceivably, controlling the high rates of serious individual and public health repercussions.

Parent-teen communication about sex in urban Thai families

This study describes sexual communication among Thai parents and their teens and identifies variables related to communication about sex in urban Thai families. Data were derived from 420 families whose teenage children ages 13-14 years were randomly selected using the probability proportional to size technique. Interviews were conducted with 1 parent and 1 teenage child in each family. In-depth interviews were also conducted in 30 parents and teens drawn from the same 420 families. Results showed that parents were most likely to talk with their teens about body changes and dating; however, less discussion about sex-related issues, birth control, and HIV/AIDS occurred. More daughters than sons reported frequent discussions with their parents about sex. Parents who believed their teens had been involved in sexual activity were more likely to talk about HIV/AIDS and the difficulty of teenagers having babies, instead of talking about sexual intercourse or when to start having sex. Multiple regression analysis indicated that gender of the child (female), parental religiosity, and parental perception of teen sexual activity were significant predictors of increased sexual communication in Thai families. The findings suggest a need for approaches designed to facilitate communication skills about sex-related issues among Thai parents.

Associations between three characteristics of parent-youth relationships, youth substance use, and dating attitudes

Various dimensions of parenting have been associated with youth risk behaviors, such as substance use and dating violence. These associations have spawned many prevention strategies that focus on parenting. However, it is unclear which characteristics of parent-youth relationships, and thus, which parent-focused prevention strategies, may be most influential in youth risk behaviors and, thus, which should be targeted in prevention. Using responses from the YouthStyles 2007 survey (N = 1,357), this study identified three youth-reported parent-youth relationship characteristics: communication about risk behaviors, closeness/respect, and rules/monitoring. The authors examined the associations among these characteristics and youths' demographics, attitudes supporting controlling dating relationships, and use of alcohol, marijuana, and tobacco. Results suggested risk behavior communication was more frequently reported by girls and was more frequent among older youth. Closeness/respect and rules/monitoring were more frequent among younger youth. Regressions suggested communication about risk behaviors was not a predictor of attitudes supporting controlling dating relationships but was a significant predictor of substance use, closeness/respect and rules/monitoring predicted substance nonuse and attitudes unsupportive of controlling dating relationships. The findings suggest that parental communication alone may not be sufficient to influence youth risk taking, but that parental monitoring and the establishment of respectful, close relationships with children may be important elements of parent-focused health promotion efforts.

Determinants of multimethod contraceptive use in a sample of adolescent women diagnosed with psychological disorders

Objective. Despite recommendations for concurrent use of contraceptives and condoms to prevent unintended pregnancy and STIs, multimethod contraceptive use among women is poor. This study examined individual-, interpersonal-, and environmental-level factors that predict multimethod use among sexually active adolescent women diagnosed with psychological disorders. Methods. This multisite study analyzed data from 288 sexually active adolescent women who provided sociodemographic, psychosocial, and behavioral data related to birth control and condom use. Results. 34.7% of the participants reported multimethod use in the past three months. Controlling for empirically and theoretically relevant covariates, a multivariable logistic regression identified self-efficacy, multiple partners, pregnancy history, parental communication, parental norms about sex, and neighborhood cohesion as significant predictors of multimethod use. Conclusions. While continued targeted messages about multi-method contraceptive use are imperative at the individual level, an uptake in messages targeting interpersonal- and environmental-level factors such as adolescents' parents and the broader community is urgently needed.

The birds, the bees, and the HPVs: what drives mothers' intentions to use the HPV vaccination as a chance to talk about sex?

Parent-child communication about sex is a way to protect adolescents from engaging in risky behavior. The human papillomavirus vaccine provides mothers with a teachable moment to communicate about sex. This study examines mothers' intentions to talk about sex in conjunction with the vaccination of daughters ages 9 to 15 years, using the Theory of Planned Behavior as a framework. A random sample of mothers was surveyed (N=217). Findings indicated that mothers' intentions were driven by attitudes, subjective norms, and the age at which they intended to vaccinate. Efforts to encourage vaccination should concentrate on strengthening mothers' attitudes about the value of talking about sex and highlight referent persons who support communication about sex.

The impact of mental health problems and religiosity on African-American girls' HIV-risk

We investigated the relationship between religiosity, mental health problems, and two sexual risk behaviors-condom use and number of partners. Participants were 80 sexually active African American girls in psychiatric care and their caregivers. Results indicated differential relationships, depending on parent versus youth report. Mother's religiosity was positively related to girls' condom use and not to girls' number of partners. Controlling for other predictors in the models, mother's religiosity explained as much as 15% of the variance in girls' condom use. Whereas parent and adolescent reports of girls' depression/anxiety and rule-breaking were positively associated with number of partners, reports of aggression were associated with having fewer partners. Neither parent nor youth reports of girls' mental health problems were associated with condom use. Controlling for other predictors in the models, girls' mental health problems accounted for as much as 31% of the variance in number of partners. Findings underscore the importance of adopting an ecological framework to understand both the risk and promotive factors for sexual risk taking among troubled girls. The roles of specific aspects of psychopathology and religiosity in relation to sexual risk behavior among African American girls in psychiatric care are discussed.

Neighborhood environment, sexual risk behaviors and acquisition of sexually transmitted infections among adolescents diagnosed with psychological disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.

Multi-system influences on adolescent risky sexual behavior

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.

Mothers of adolescent girls: comparing HIV positive and HIV negative women

BACKGROUND

HIV+ mothers of adolescent girls can serve as agents of change, particularly when it comes to preventing patterns of behaviors that are inherently dangerous. In order to do so these women need to be able to communicate with their daughters and educate them about risk behaviors, especially those associated with HIV acquisition. The objective is to describe the sociodemographic and risk profile in a sample of mothers of adolescent girls who are HIV+ or HIV negative and analyze differences between them.

METHODS

A convenience sample was recruited from three sites, the Universidad Central del Caribe School of Medicine, the UPR School of Medicine, and the Ponce School of Medicine. Six focus groups, two in each institution, were conducted following Krueger's methodology with the objective of developing an educational intervention for mothers of adolescent girls. All participants completed two self-administered questionnaires prior to the focus group. A data analysis was performed--descriptive statistics for the sociodemographic measures included frequencies, percents, mean and SD. We used t test and the Fisher's exact test to analyze differences between groups.

RESULTS

A total of 44 participants were enrolled, with 50% being HIV positive mothers and 50% being HIV negative mothers. The mean age for both groups was similar (41 years). Statistically significant differences (P < .05) were observed among HIV diagnosis and for the following variables: education, working status, income, marital status, age at first intercourse, and illicit drug use.

CONCLUSIONS

It is possible that the sociodemographic characteristics of HIV+ women affect their parenting and communication skills. The same factors that may have led to these women being infected by HIV in the first place might in addition be compromising their roles as effective parents.

Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality-sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent's sexual health.

The moral justification for a compulsory human papillomavirus vaccination program

Compulsory human papillomavirus (HPV) vaccination of young girls has been proposed as a public health intervention to reduce the threat of the disease. Such a program would entail a symbiotic relationship between scientific interests in reducing mortality and morbidity and philosophical interests in promoting morality. This proposal raises the issue of whether government should use its police powers to restrict liberty and parental autonomy for the purpose of preventing harm to young people. I reviewed the scientific literature that questions the value of a HPV vaccination. Applying a principle-based approach to moral reasoning, I concluded that compulsory HPV vaccinations can be justified on moral, scientific, and public health grounds.

Development of a Web-based program to improve communication about sex

Adolescent sexual risk behavior is a serious and prevalent problem among American youth. Mothers may play a key role in discussing sex and sexual risk behavior with their adolescent children. However, mothers may lack the knowledge and skills to successfully communicate. The purpose of this study was to develop a Web site to teach mothers how to communicate with their children about sex and to demonstrate the efficacy of this Web-based program. This pilot study included 35 rural, low-income mothers of middle-school adolescents. Mothers were randomly assigned to either the Web-based experimental group or written information-only control group. Mothers in the experimental group received computers and Internet access to the Web-based program, peer support, and expert advice from a pediatric nurse practitioner. Major findings of the study were that the Web-based intervention was equally effective at improving mothers' knowledge, communication skills, and self-efficacy as the written material control and that low-income rural women who have had little to no prior experience with computers can effectively learn Web-based health-related information. Future implications for nursing are discussed.

Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial

OBJECTIVES

To test the effectiveness of the CHAMP among black South Africans in KwaZulu-Natal, South Africa.

METHODS

A randomized control trial was conducted in KwaDedangendlale, South Africa, among youths (ages 9-13) and their families (245 intervention families rearing 281 children and 233 control families rearing 298 children). The CHAMPSA intervention targeted HIV risk behaviors by strengthening family relationship processes as well as targeting peer influences through enhancing social problem solving and peer negotiation skills for youths.

RESULTS

Among caregivers in the control and experimental conditions, significant intervention group differences were revealed regarding HIV transmission knowledge, less stigma toward HIV-infected people, caregiver monitoring-family rules, caregiver communication comfort, caregiver communication frequency and social networks. Among youths, data revealed that control and experimental groups were significantly different for children in AIDS transmission knowledge and less stigma toward HIV-infected people.

CONCLUSIONS

CHAMPSA enhances a significant number individual, family and community protective factors that can help youths avoid risky behaviors leading to HIV-positive status.

Parent-adolescent sex communication in China

BACKGROUND

Communication concerning sexual matters between parents and their adolescent children serve as a protective factor and exerts a favourable influence on adolescents' sexual behaviours. As limited data regarding parent-adolescent sex communication are available in China, this study was undertaken with the aim of exploring the patterns and related factors of such communication and its relationship with adolescent sexual behaviour.

STUDY DESIGN

Community-based data were collected in 2001 in Changchun, China. Unmarried adolescents 15-19 years of age (322 young men and 360 young women) were included in a survey using self-administered questionnaires.

RESULTS

Overall, sex communication with parents was relatively infrequent. There was a significant gender difference in the pattern of sex communication, with male adolescents being more likely to talk with fathers and female adolescents with mothers. Logistic regression analysis revealed that gender of adolescents, quality of communication with mothers on general topics, and adolescent's perception of mother being the main source of sex knowledge were predictive of the level of sex communication between mother and her adolescent children.

CONCLUSION

This study reveals that communication regarding sexual matters between parents and adolescents was limited in China. The quality of communication on general topics between parents and their adolescent children is one of the important factors related to sex communication between them. It is essential that Chinese parents are better informed and skilled to be involved, in addition to school and community, in the sex education of their adolescent children. They should be able to communicate appropriately on sex-related issues with them.

Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood

This study compared young adults (ages 18 to 26) with and without childhood attention deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors. Participants were 175 men with childhood ADHD and 111 demographically similar men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. Although childhood conduct problems did contribute significantly to risky sexual behaviors among participants with ADHD, there was also an independent contribution of ADHD, suggesting that the characteristic deficits of the disorder or other associated features may be useful childhood markers of later vulnerability.

Family context and HIV risk among youth in psychiatric care: what pediatricians can do

PURPOSE OF REVIEW

The HIV/AIDS epidemic is one of the most widespread public health problems today. Teens with mental health concerns are particularly vulnerable to infection because they engage in higher rates of risky behaviors than their peers. Families are vital influences in protecting teens from HIV exposure, but parents often feel unprepared to discuss sexual behavior with teens. This review provides an overview of the role of teens' mental illness in HIV risk and suggests guidelines for pediatricians to facilitate parents' ability to keep teens safe from risky behaviors.

RECENT FINDINGS

Young people account for more than 50% of new infections each year, and mental health problems are related to increased risk taking via inconsistent condom use, multiple partners, and decreased assertiveness. Parents can protect youth from engaging in HIV risk behaviors through supervision, providing support, and communicating effectively about sexual topics.

SUMMARY

Pediatricians can support parents in keeping youth safe from HIV infection by openly discussing ways to reduce teens' risk of exposure. Talking to families about risks, empowering parents to address issues with teens, and providing referrals for parents to build a network of support can reduce mental health problems and HIV risk among teens.

Racial differences in parenting dimensions and adolescent condom use at sexual debut

OBJECTIVES

Parenting style may be a determinant in reducing adolescent risk behavior. Previous studies have relied on a typological parenting approach, with classification into four groups: authoritative, authoritarian, permissive, and neglectful. In this study, two distinct parenting dimensions, demandingness and responsiveness, were examined as independent predictors of adolescent condom use.

DESIGN AND SAMPLE

This study used a subsample of the National Longitudinal Study of Adolescent Health (Add Health) that included 153 adolescent-mother pairs.

MEASUREMENT

Maternal demandingness and responsiveness were measured using Wave I mother interviews. Logistic regression analyses were used to predict adolescent condom use at sexual debut at Wave II and to assess moderation by gender and race.

RESULTS

(1) Maternal demandingness predicted increased likelihood of condom use in African American adolescents but decreased likelihood of condom use in White adolescents; (2) maternal responsiveness did not predict condom use; and (3) gender moderation was not present.

CONCLUSIONS

To provide appropriate family counseling, public health nurses need to consider racial differences in contraceptive practices. Education regarding parental supervision practices should be considered as part of nursing interventions intended to increase condom use in African American adolescents.

Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade

Interpersonal communication processes are central to the provider-patient interaction and in relationships with someone who is ill or needs care. The last decade of research has documented the ways communication processes predict better outcomes in the provider-patient interaction and key constructs for consideration in close relationships in which a health issue in some way defines the relationship. The current article highlights findings from the previous decade and the ways previous findings serve as a theoretical and methodological foundation for more sophisticated analysis of interpersonal communication processes in health contexts. A relational perspective serves as a link between the provider-patient relationship and close relationships with someone with a health issue. Implications for provider-patient contexts, medical education, and close relationships highlight future directions for theory building, health literacy, health outcomes, family communication, developmental issues, and a life span perspective.

Youths and HIV/AIDS: psychiatry's role in a changing epidemic

OBJECTIVE

To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments.

METHOD

Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment.

RESULTS

Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems.

CONCLUSIONS

HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.