In a recent nationwide survey, nearly half (47%) of US youths aged 12 to 14 years said their parents influence their decisions about sex more than anyone else.1
Nearly all (87%) said it would be much easier to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations with their parents about sex, contraception, and pregnancy.
A key strategy for leveraging the power of parents and increasing positive family interactions to reduce risks for teen pregnancy and sexually transmitted diseases (STDs), including HIV/AIDS, is to involve parents and children in prevention education programs. Researchers2–4
have found that parent–child interventions can have positive effects on children's knowledge and attitudes about sexual health, as well as improve parent–child communication. The research literature indicates less certainty regarding the longer-term effects of parent–child education programs. Recent reviews of the literature5,6
revealed only 2 experimental studies of joint parent–child education programs that included longer-term follow-up to evaluate the impact on adolescent behavior. In one of these, a 1993 study of a video-based program for home viewing by parents and children, Miller et al7
found no effect on postponement of sexual debut. In the other, a 1997 study of parent interactive activities in a school-based HIV prevention program, Weeks et al8
found no effect on sexual frequency.
Researchers and health practitioners have concluded that simply bringing adolescents and parents together is not sufficient.4
They have advised that well-designed interactive activities in which adolescents and their parents talk with and learn from each other during prevention education sessions may be more effective in reducing the risks of adolescent pregnancy and STDs.
We conducted this research study to determine the effects of integrating interactive parent–child activities into an after-school prevention education curriculum for middle-school students and their parents. The curriculum, titled Parent–Adolescent Relationship Education (PARE),9,10
is presented in an initial series of 4 weekly small-group sessions followed by a single-session booster in each of 3 subsequent semesters, for a total of up to 18 hr of prevention education distributed across a 2-year period. (The purpose of the booster sessions was to bring the parents and adolescents together and explore their successful and unsuccessful experiences with their peer and familial relationships over the previous months. Booster, or maintenance, sessions are provided after the initial intervention class series to review content and skills, to reinforce prevention messages to reduce and manage risk, and to foster continued parent–teen communication and interaction.) The curriculum is targeted to middle-school-aged youths because sexual activities often are initiated in the early teen and preteen years and because sexual initiation is occurring at increasingly younger ages, especially among urban minority youths.11
The social learning and behavioral cognitive theories on which the PARE curriculum was framed hold that adolescent behavior is subject to social and self controls.12–15
Social-controls can be direct (eg, parental rules) or indirect (eg, youths not wanting to disappoint those whose opinions are valued). Self controls can be cognitive (eg, knowledge about risks and protections), emotional (eg, feeling confident about one's capabilities for obtaining protective devices), and behavioral (eg, having a broad repertoire of appropriate response alternatives for coping with pressures to have sex).
Social controls addressed in the PARE curriculum include communication about sex, values assigned to parents' and friends' opinions, parental rules about adolescent behavior, and parental monitoring through involvement in youths' activities. Key aspects of youths' self-control targeted in the curriculum are knowledge, self-efficacy, and behavioral options for prevention of pregnancy and STDs, including HIV/AIDS.
The PARE curriculum was delivered either as an Interactive Program (IP) with role-play, practice exercises, and parent–child discussions or as an Attention Control Program (ACP) that contained the same content but was delivered in traditional didactic format. The IP differed from the ACP in its inclusion of the following behavioral, cognitive, and social learning modalities:
- Teacher and peer modeling of communication and assertiveness behaviors, and the practice of these behaviors through role-playing.12
- Activities to personalize information about sexuality and reproduction.13
- Guided practice opportunities for applying problem solving, decision making, and assertive communication skills in difficult situations.14
- Exercises to enhance self-efficacy for protecting against teen pregnancy, HIV, and STDs.15
- Facilitated opportunities for parents and youth to discuss and process the information presented and their experiences with applying new knowledge and skills.
We hypothesized that the social interactive activities and parent–child discussions designed into the IP approach for curriculum implementation would prove more effective than the ACP in maintaining and strengthening social and self controls on adolescent sexual behavior.