Family Adolescent Risk Behavior and Communication Study

A recent study conducted by the Epidemiology Branch of CDC's Division of HIV/AIDS Prevention examines how selected individual, familial, peer, and environmental factors influence HIV risk and risk-reduction behaviors among adolescents aged 14-17. Interview data were collected from 907 adolescent-mother pairs recruited from public high schools in San Juan, Puerto Rico; Montgomery, Alabama; and the Bronx, New York. One important study focus is on the role of mother-child communication about sex, examining how the content, process, and timing of this communication relates to adolescents' sexual risk behaviors.

More comprehensive or broader messages encompassing a greater number of sex-related topics that were delivered by the mother were associated with less sexual risk behavior among adolescents.¹

Mothers who were skilled communicators about sex-related topics were more likely to discuss a broad range of sex-related topics with their adolescent, and were more likely to be heard by their adolescent during those discussions.²

When mother-child discussions were conducted in an open and responsive manner, greater discussions of sex and sexual risk promoted adolescents' communication with their partners about sexual risk and adolescents' condom use.³

Timing of mother-adolescent discussions about condoms is critical. Mother-adolescent communication was associated with greater condom use at first intercourse only when it occurred before the adolescent's first sexual encounter. Adolescents who talked with their mothers before their first sexual encounter were 3 times more likely to use a condom than adolescents who did not talk with their mothers. This is important because condom use at first intercourse strongly predicted future use. Adolescents who used condoms at first intercourse were 20 times more likely to use condoms regularly in subsequent acts.⁴

Not talking about sex can be consequential because adolescents can be influenced by other sources, such as peers. Adolescents who did not discuss sex or condoms with their mothers showed a stronger correspondence between peer norms and their own behavior compared with adolescents who did discuss sex or condoms with their mothers. This can be a problem if peers do not encourage responsible behavior.⁵

Implications for Prevention Programs

Findings from this research suggest important areas that can and should be addressed in HIV prevention interventions: delivering comprehensive messages, parental skill and sensitivity in discussing sex, and the timing of the communication.

Comprehensive messages are those that encompass discussion on a range of sexuality topics, such as sexual decision-making, menstruation, reproduction, physical/sexual development, when to start having sex, birth control, condoms, choosing sexual partners, masturbation, STDs, and HIV/AIDS.

Characteristics related to parental skill and sensitivity in discussing sex include having accurate information about the topics, talking openly and freely rather than lecturing or threatening, welcoming questions from the adolescent, and listening to the adolescent's concerns and feelings about the topics.

Sexuality education should begin early as part of a lifelong process of acquiring information and forming attitudes, beliefs, and values, rather than just "the talk." It encompasses learning about sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles. Issues related to sexuality become more salient as sexual feelings emerge in early adolescence. The sexual foundation built within the family through verbal and nonverbal communication and modeling of attitudes, beliefs, and behaviors about sexuality plays an important role in fostering a sexually healthy adolescent.

The results underscore the significant role mothers can play in preventing HIV among adolescents and highlight the importance of parents being able to discuss sex in an open and responsive way. Programs should seek to involve parents in their children's HIV prevention education. In addition, separate programs that provide parents with skills and strategies to talk with their children about sexuality throughout childhood are of great value. These programs may be offered by a variety of organizations, including YMCAs/YWCAs, churches and synagogues, work sites, Parent-Teacher Associations (P.T.A.), and community-based organizations.

Additional Resources for Parent-Child Communication about Sex

Kaiser Family Foundation
2400 Sand Hill Road
Menlo Park, CA 94025
Phone: (650) 854-9400
Web site: www.kff.org/homepage

National Campaign to Prevent Teen Pregnancy
2100 M Street NW
Suite 300
Washington, D.C. 20037
Phone: (202) 261-5655
Web site: www.teenpregnancy.org

What Every Teenager Really Wants to Know about Sex (book)
by Sylvia Hacker, Ph.D.
Carroll & Graph Publishers (1993)
19 West 21st Street, Suite 601
New York, NY 10010
Phone: (212) 627-8590

Raising Healthy Kids: Families Talk about Sexual Health (video)
Media Works
P.O. Box 15597 Kenmore Station
Boston, MA 02215
Phone: (978) 282-9970
Web site: www.abouthealth.com

References

1. Dutra R, Miller KS, Forehand R. "The process and content of sexual communication with adolescents in two-parent families." AIDS and Behavior. In press.

2. Miller KS, Kotchick BA, Dorsey S, Forehand R, Ham AY. "Family communication about sex: what are parents saying and are their adolescents listening?" Family Planning Perspectives 1998; 30(5): 218-222 & 235.

3. Whitaker DJ, Miller KS, May DC, Levin ML. "Communication between teens and their partners about sex and sexual risk and teens' condom use: the importance of the parent-teen communication process." Manuscript submitted for publication.

4. Miller KS, Levin ML, Whitaker DJ, Xu X. "Patterns of condom use among adolescents: the impact of maternal-adolescent communication." American Journal of Public Health 1998 Oct; 88(10): 1542-1544.

5. Whitaker DJ, Miller KS. "Parent-adolescent discussions about sex and condoms: impact of peer influences on sexual risk behavior." Manuscript submitted for publication.