This study augments growing evidence that youth in psychiatric care risk exposure to HIV through sexual risk taking. Findings shed new light on the role of parents in troubled teenagers’ risky sexual behavior, and they reveal potentially different risk mechanisms for troubled boys and girls and for different sexual risk behaviors. Results uncover unique links between different types of sexual risk taking and parenting styles, especially for girls, thereby underscoring the need for gender-sensitive, risk specific, family-focused HIV prevention programs.
Youth in this study reported high rates of sexual risk taking, and risky sexual behavior (i.e., sex while using drugs and alcohol, sex without a condom, and sex with a high risk partner) increased with age. These findings support earlier research (; DiClemente & Ponton, 1993
; Kotchick, Shaffer, Miller, & Forehand, 2001
), but extend the literature to youth in outpatient psychiatric care. Consistent with our hypothesis and with earlier research, girls reported more risky sex than boys at a global level (CDC, 2000a
; DiClemente et al., 1996
; Newman & Zimmerman, 2000
), but gender differences were not uniform across specific risk behaviors; whereas being female was associated with a greater likelihood of having sex without a condom, being female was not statistically associated with the other narrow-band behaviors (i.e., more sexual partners, sex with a high-risk partner, or sex while using drugs). These findings partially support data on normally developing adolescents that suggest boys are more likely to have multiple partners and girls are less likely to use condoms (CDC, 2000b
; Kotchick et al., 2001
). These data underscore the importance of identifying gender-specific risk mechanisms in order to appropriately tailor HIV prevention programs for boys and girls.
Findings partially supported our predictions about gender differences in parenting behaviors. Although not statistically significant, girls tended to perceive more parental monitoring than boys (p
=.067), but girls and boys did not differ significantly in their perceptions of parental permissiveness, although means were in the expected direction (M
= 9.97 and SD
= 4.00 for girls, and M
= 10.65 and SD
= 3.54 for boys). Gender differences in relation to parental monitoring are widely reported in the literature (Black et al., 1997
; Li et al., 2000
; Romer et al., 1999
), but there is less evidence to support gender differences in relation to parental strictness or permissiveness. Parents may monitor their daughters more than their sons to protect them from more damaging long-term consequences of high-risk behavior for girls, such as pregnancy. On the other hand, the uniformly strained parent-adolescent relationships of girls and boys in psychiatric care may make parents equally permissive with their daughters and sons to avoid further family conflict. In any case, our data suggest that it is important to distinguish parental monitoring from parental permissiveness because they may be differentially related to risk processes in girls and boys.
Consistent with our expectations, gender moderated the link between sexual risk taking and perceived parental permissiveness for global and specific risk taking behavior. When parental permissiveness was high, girls but not boys reported increased sexual risk taking, a greater likelihood of using drugs and alcohol while having sex, and a decreased likelihood of using a condom during sex. However, rates of risky sexual behavior among girls and boys did not differ when parental permissiveness was low. Contrary to our predictions, gender did not influence the relationship between perceived parental monitoring and risky sexual behavior at either a global or specific level, after controlling for age. Taken together, these findings indicate that adolescent perceptions of parental monitoring and parental permissiveness are more strongly associated with sexual risk taking in troubled girls than troubled boys.
One reason for the gender difference observed in this study may be the strong emphasis girls place on maintaining relationships, especially with parents (Chodorow, 1974
; Gilligan, 1982
; Taylor et al., 1995
). Perceptions of permissiveness could reflect greater family dysfunction in general, which may be especially salient for girls because of their high need for interpersonal connection. In addition, less parental permissiveness (i.e., more strict parenting) may be experienced by girls as an act of concern for their safety, health, and well-being, whereas they may interpret permissive parental attitudes as a lack of concern or connectedness. When girls feel that their parents are concerned and involved, they may be less likely to engage in risky sexual behavior in order to sustain close family ties and avoid parental disapproval and family conflict.
Moreover, highly permissive parent-child relationships may lack intimacy and responsiveness (Minuchin, 1974
), and girls may view their parents as detached, disengaged, and unconcerned. This perception may diminish girls’ motivation to sustain a strong parent-adolescent bond. They may be less likely to anticipate family conflict and parental disapproval resulting from their risky behavior and, therefore, more likely to seek closeness and intimacy with peers and partners. Many girls convey a reluctance to assert themselves in the context of intimate relationships and a tendency to sacrifice their own needs, feelings and beliefs to please others or avoid conflict and disconnection (Gilligan, 1991
; Spinazzola, Wilson, & Stocking, 2001). Responsible sexual behavior, such as abstaining from sex or insisting on condom use, is a potential source of conflict with and even rejection by romantic partners. Engaging in risky behavior may be viewed as a way of gaining acceptance from peers and/or securing a partner’s love and commitment. For girls in psychiatric care whose family and interpersonal relationships are already strained, practicing preventive behaviors may be a low priority if it means risking rejection or disapproval from partners and peers. Thus, girls who do not perceive clear limits and expectations from parents may be less motivated to maintain a connection with their parents. By attempting to ensure interpersonal connection in other relationships, they may place needs for intimacy and acceptance with sexual partners or peers above safe behavior thereby compromising their own health.
Alternatively, it is possible that girls who perceive their parents as more permissive also obtain less parental guidance in how to negotiate sexual relationships, and thus, rely on cultural stereotypes of female submissiveness in partner relationships. Girls often have sexual relationships with older boys/men (Ford, Sohn, & Lepkowski, 2001
), and they may be more vulnerable to pressure by older partners not to practice safe sex, especially troubled girls who are seeking reassurance and intimacy through these encounters. Research suggests that teens are less likely to use contraception at first intercourse when their partner is significantly older (Abma, Driscoll, & Moore, 1998
). Girls in psychiatric care may be especially unlikely to assert themselves in sexual relationships and more vulnerable to partner pressure to engage in high-risk sexual activity. Boys, on the other hand, may receive less attention regarding sexual education from parents than girls (Miller & Fox, 1987
), and therefore may be less influenced by a lack of parental involvement.
This study revealed an important connection between adolescent perceptions of parenting and risky sexual behavior in troubled adolescents, particularly for girls, but further research is needed to clarify the role of other parent-adolescent relationship factors such as warmth, rejection, and communication, in teenagers’ sexual risk taking. Research suggests that adolescents are better able to take on adult responsibilities like planning for HIV prevention when they are encouraged to rely on themselves but have parents clearly available for support and advice (Grotevant & Cooper, 1986
; Peterson & Leigh, 1990
). Thus, in conjunction with adequate parental monitoring and strictness, other aspects of the parent-teen relationship, such as open communication about sexuality, may foster autonomy and responsible sexual decisionmaking. Likewise, research on other important adolescent relationships that influence sexual behavior, such as peer and partner relationships, is also vital to understanding the social-interpersonal context in which clinically disturbed adolescents’ sexual behavior takes place and to clarify the mechanisms through which parenting may influence teenagers’ sexual behavior.
This study found a somewhat weaker and less compelling connection between parenting and risky sexual behavior in boys. Some research suggests that hormones may be more important than social influences in boys’ sexual behavior (Miller & Fox, 1987
; Udry, Billy, Moms, Groff, & Raj, 1985
), but other intrapsychic factors or parenting behaviors likely play an important role in reducing boys’ risk taking (Jaccard, Dittus, & Gordon, 1996
; Resnick et al., 1997
). Parenting practices (e.g., encouragement to take AIDS precautions) or risk behaviors (e.g., drug use) not studied here may be more salient for boys than for girls’ risk behavior. Additional research is needed to identify the intrapsychic factors, parenting practices and parent-adolescent relationship characteristics related to reduced risk behavior among troubled boys.
Like many studies of sexual risk taking (Li et al., 2000
; Millstein & Moscicki, 1995
), we used a global index of risky sex. However, we also went beyond a global score by analyzing specific forms of risk taking, and in doing so, we were able to pinpoint unique patterns for which adolescent perceived parental permissiveness does (i.e., sex while using drugs/alcohol and sex without a condom) and does not (i.e., number of sexual partners and sex with a high-risk partner) predict greater risk among girls than among boys. This study underscores the importance of assessing global and specific types of risk behavior in order to obtain the most informative patterns.
Study limitations warrant cautious interpretation of these results. This study tested adolescent perceptions of parenting styles, and their reports do not necessarily reflect true parental behavior. However, these data suggest that adolescent perceptions play an important role in their sexual behavior, and in the same way that HIV prevention has emphasized changing adolescent perceptions of peer norms regarding sexual behavior, these data support changing adolescent perceptions of parental behavior in order to alter sexual risk taking. We assessed adolescent, rather than parent, perceptions of parental monitoring and permissiveness. Adolescent perceptions are only one indication of parental monitoring and permissiveness, and parent reports of these behaviors may have direct or indirect effects on adolescents’ risk behavior. To test this possibility, we reran our analyses of all dependent measures substituting parent-reported levels of monitoring (the study did not include a measure of parent-reported permissiveness) instead of adolescent-reported levels of monitoring. Parent-reported monitoring had nonsignificant effects for the pooled sample, as well as for males and females when analyzed separately. Indeed, parent and adolescent reports of parental monitoring correlated only .26 (p < .002, two-tailed, d = .54) in the pooled sample, indicating that the two measures are largely independent (r2 = .07). In any case, our findings suggest that adolescent perceptions of parental behavior are related to adolescents’ sexual risk taking, and, thus, prevention programs that change these perceptions have the potential to reduce risky sex in these teens.
The parenting scales used in this study do not assess monitoring and permissiveness in relation to adolescent sexuality or sexual experiences specifically. It is possible that measures of parental monitoring and permissiveness focused on sexual behavior might yield different patterns in relation to teens’ sexual risk taking. Nonetheless, these results underscore the important role of adolescent perceptions of parental monitoring and permissiveness in their sexual risk behavior. These data are cross-sectional, and without longitudinal follow-up, the direction of cause-and-effect cannot be established. It is conceivable that adolescents who engage in risky sexual behavior might perceive their parents as more permissive as a means of justifying or rationalizing their behavior. It is also possible that this tendency is stronger among girls than among boys because it is especially important for girls to feel connected with parents. In either case, patterns identified in this study can inform family-based, gender-sensitive prevention programming.
Findings are restricted to adolescents in psychiatric care and may not generalize to other youth. However, this group has shown itself to be at especially high risk for HIV (; Donenberg et al., 2001
), and the results provide insight into the links between parenting styles and HIV risk in this group. Data are desperately needed to guide targeted HIV prevention programs for teens in psychiatric care, and findings from the present study offer initial directions for this purpose. Results do not apply to wards of the state, a high-risk teenage subgroup deserving of careful study because of their extensive abuse histories and the evidence that abuse increases HIV risk (Brown, Kessel, Lourie, Ford, & Lipsitt, 1997
). The parenting practices of foster parents toward youth who are wards of the state may be related to teenagers’ sexual risk taking in different ways than those found here and should be examined. This study focused exclusively on risky sexual behavior despite evidence that these teenagers engage in high rates of other HIV risk behaviors (Donenberg et al., 2001
). However, for youth, HIV is mainly transmitted through unprotected sexual intercourse and other high-risk sexual behavior (DiClemente, 1996
; Pequagnat & Szapocznik, 2000), and, thus, understanding and preventing sexual risk taking in this group is the most effective way to curb the spread of HIV in this population.
This is one of the first investigations to identify parenting styles associated with treatment seeking teenagers’ high-risk sexual behavior. The findings support ecological theories of risk behavior and justify HIV prevention programs that target a broader social context (Bronfenbrenner, 1986
; Perrino et al., 2000
). Our data underscore the importance of gender-sensitive, family-focused HIV prevention programs that include key family members and strengthen parental supervision and strictness to reduce troubled youth’ risky sexual behavior, especially among girls for whom the effects were strongest and who are fast becoming one of the groups at greatest risk of HIV/AIDS.