National Partnership for Women & Families

Monthly Women's Health Research Review

Editorial Reviews Meta-Analysis on Parent-Adolescent Communication About Sexual Activity, Contraception

Summary of "Parent-Adolescent Communication About Contraception and Condom Use," Guilamo-Ramos et al., JAMA Pediatrics, January 2016.

"A significant number of sexually active youth experience poor sexual and reproductive health outcomes, including [unintended] pregnancy, sexually transmitted infections, and human immunodeficiency virus infection," according to Vincent Guilamo-Ramos of New York University's Center for Latino Adolescent and Family Health and colleagues. They noted that there are more than 600,000 pregnancies among teens each year, "and approximately half of all new [STIs] are attributed to youth aged 15 to 24 years."

According to the researchers, although "[e]xtensive scientific literature suggests that parents play an important role in shaping sexual behavior among adolescents ... there is a tendency in this research to prioritize delaying adolescent sexual debut, with less attention devoted to correct and consistent condom and contraceptive use."

The researchers discussed a meta-analysis by Widman et al. that "examine[d] correlations between parent-adolescent sexual communication and adolescent use of contraceptives and condoms" and found "that parental communication is positively linked to safer sex behavior among adolescents." According to the researchers, the editorial "expand[s] on the findings by Widman et al by highlighting conceptual and methodological issues that bolster the effect and association of parent-adolescent communication on adolescent contraception and condom use."

Role of Parent-Adolescent Communication Theories

The researchers noted that "[w]ell-established communication frameworks identify multiple factors to consider to strengthen communication between parents and their children," including content, context, frequency, source, style, timing and target, such as boys or girls.

However, the researchers found "that most (36 studies)" included in the Widman et al. meta-analysis "reported a single indicator of parent-adolescent sexual communication, and only 15 studies reported 6 or more communication items." According to the researchers, "Such assessments neglect the complex and multifaceted dynamics of parent-adolescent communication and limit the magnitude of associations between communication and behavior accordingly."

Further, the authors wrote that "[w]hile messages about 'general sex topics' can be part of the ongoing discussion between parents and adolescents, specificity in the discussion, particularly about use of contraceptives and condoms, are likely more predictive in shaping these behaviors." They noted that "contraceptive behavior itself is a complex construct consisting of method choice, consistency of method use, accuracy of method use, and switching between methods." According to the editorial, "Research shows that the factors that affect one facet may not be the same as those affecting another facet." As a result, "[p]arents must focus their communication efforts on strong correlates of adolescents' use of contraception and/or condoms," the researchers wrote.

The researchers explained that "[i]ncreased attention to rich, theoretically driven communication frameworks will strengthen the effect of parent-adolescent communication on the use of contraceptives and condoms." However, according to the researchers, "The studies included in the [meta-analysis] ... generally do not embrace current theories of communication or behavior."

Maternal vs. Paternal Influence

"Too often, research focused on parents is unclear about whether mothers or fathers are the focus," the researchers wrote, adding that this "failure ... represents a challenge for parent-communication analysis." According to the researchers, the meta-analysis "suggests that maternal communication is more strongly associated with safer sex behaviors among adolescents relative to paternal communication," but, "as Widman et al point out, this difference may be attributed to our limited understanding of paternal-adolescent communication." The researchers called for further research on how fathers influence adolescents safer sex behaviors, citing the "limited numbers of studies" that focus on such issues and noting that "only 5 studies" in the meta-analysis focused on fathers.

Sex Differences in Parental Influence

The researchers also noted that "[t]he stronger association of parental sexual communication for girls relative to boys suggests potential sex dynamics regarding parent-adolescent communication."

According to the researchers, "[t]he finding highlights that boys potentially have unique determinants (eg, masculinity, gender role identity) of sexual behavior to be addressed in parent-adolescent discussions." However, "research has tended to focus on girls, with limited attention to boys and their sexual and reproductive needs," the researchers wrote. They noted, "Given that young males experience additional barriers to sexual and reproductive health relative to girls, parents represent a resource for providing clear messages about use of contraceptives and condoms."

Inclusion of Diverse Families

"Recognition of the importance of racial and ethnic diversity and adolescents who are sexual minorities warrants mention," the researchers wrote, noting that "[v]ariation in demographic, cultural, and social factors regarding how families communicate about safer sex behavior can weaken the overall effect estimate." According to the researchers, the meta-analysis "includes studies from several different countries, integrating a broad and diverse population of families."

The researchers cited a "growing interest in identifying adolescent sexual health interventions that are efficacious with minority families, which is in part owing to the growth of racial ethnic minority populations in the United States and well-documented disparities in sexual and reproductive health outcomes." As a result, they urged "[g]reater attention to culturally competent approaches to parent-adolescent communication strategies."

Moreover, the researchers noted, "Largely absent in the discussion surrounding adolescent sexual and reproductive health are adolescents who are sexual minorities, who bear a disproportionate burden of [STIs] and [HIV] infections." They noted that "existing data, while limited, suggest communication may not operate in the same way for such adolescents."

Parent-Adolescent Communication and the Context of Parental Influences

The researchers wrote that although "Widman et al focus on the construct of parent-adolescent communication, they acknowledge that other parent constructs, such as parental monitoring and parent-adolescent relationship quality may interact with communication to affect adolescent sexual behavior."

According to the researchers, "Embedding communication constructs in larger parenting frameworks is essential to understanding the role of communication in shaping adolescent behavior." They wrote that "future research can benefit from a more comprehensive understanding of parenting domains that may interact when predicting adolescent sexual decision making."

Effect Size Variability

Noting that "[s]afer sex behavior is an extremely complex behavior that is undoubtedly influenced by a multitude of variables that interact in complex ways," the researchers flagged in the meta-analysis 10 study correlations that were "above 0.25." They suggested "[a] case study approach to these 10 studies rather than global meta-regressions" to better identify what variables set those 10 studies apart from the others.

Rigor and Method of Studies

According to the researchers, "The complex nature of parent-adolescent communication warrants research that integrates communication-based variables into comprehensive theories of adolescent sexual behavior," but "[m]any studies included in the review by Widman et al relied on impoverished conceptual frameworks and examined parent adolescent communication in isolation." The researchers recommended "[c]omprehensive theories of parent-adolescent communication with clear links to determinants of adolescent sexual behavior," which can help "highlight the precise mechanisms by which parental communication shapes adolescent use of contraception and condoms."

The researchers also recommended "apply[ing] higher standards in overall research designs," such as including more "randomized explanatory trials that move beyond a simple focus on whether there were outcome effects." This type of research design can also "provide insight into intervention revision." Conclusion According to the researchers, "the meta-analysis by Widman et al provides evidence that parent-adolescent communication is associated with adolescent use of contraceptives and condoms." They noted that while most "research has focused on parental influences in delaying sexual debut," sexually active adolescents "also benefit from parental discussions regarding sexual and reproductive health outcomes." The researchers concluded, "Youth want to hear from their parents and overwhelmingly say that parents matter. Hence, public health efforts should support the unique role that parents can play in sexual decision making among adolescents."