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The Relationship between Sexuality Based Parent-Adolescent Communication and

Overall Sexual Health among Selected University Students

Padjadjaran

By

Muwaga musa

A Dissertation
Proposal

Health Education
Parent-Adolescent Communication
about Sex 2

Table of Contents

Table of Contents.................................................................................................................2
Table of Tables....................................................................................................................4
CHAPTER 1
INTRODUCTION...............................................................................................................5
Background......................................................................................................................5
Statement of the Problem.................................................................................................8
Need for the Study.........................................................................................................10
Significance to Health Education...................................................................................12
Purpose of the Study......................................................................................................15
Research Questions........................................................................................................16
Research Design.............................................................................................................16
Data Collection..............................................................................................................17
Data Analyses................................................................................................................18
Assumptions...................................................................................................................18
Limitations.....................................................................................................................19
Delimitations..................................................................................................................19
Definitions......................................................................................................................19
Summary........................................................................................................................20
CHAPTER 2
REVIEW OF THE LITERATURE...................................................................................22
Overview........................................................................................................................22
Purpose of the Study......................................................................................................22
Research Questions........................................................................................................22
Adolescent Development ..............................................................................................23
Sexual Health Defined: The Sexual Health Model........................................................31
Adolescent Sexual Behavior..........................................................................................34
The Roll of Parents in the Sexual Development of Adolescents...................................37
Communication..............................................................................................................38
Content of Parent-Adolescent Sexuality-Based Discussions.........................................43
Frequency and Source of Sexuality-Based Communication.........................................48
Discrepancies in Reported Communication .................................................................55
Timing of Sexuality-Based Communication.................................................................56
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Quality and Nature of Parent-Adolescent Communication...........................................58
Beliefs and Comfort with Sexuality Based Subject Matter...........................................66
The Relationship Between Sexual Behavioral Outcomes and Parent-Adolescent
Sexuality Based Communication...................................................................................70
Barriers to Communication............................................................................................74
Other Influences on Sexual Health, Sexual Behavior, and Communication.................78
Summary........................................................................................................................85
CHAPTER 3
METHODS........................................................................................................................87
Overview........................................................................................................................87
Purpose of the Study......................................................................................................87
Research Questions........................................................................................................87
Research Design.............................................................................................................88
Sample............................................................................................................................89
Instrumentation..............................................................................................................90
The Sexual Health Inventory.....................................................................................91
Parental Communication Assessment Survey.........................................................104
Data Collection............................................................................................................107
Data Analyses..............................................................................................................108
Summary......................................................................................................................112
References........................................................................................................................113
APPENDIXES.................................................................................................................125
Appendix A
Pilot Study Descriptive Statistics for Individual Items in the Sexual Health Inventory
......................................................................................................................................126
Appendix B
Pilot Study Descriptive Statistics for Individual Items in the Relationship Satisfaction
Scale.............................................................................................................................135
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Table of Tables

Table 1
Sexual Health Inventory Items...........................................................................................92
Table 2
Elements of Sexual Health described in the Sexual Health Inventory..............................96
Table 3
Demographics of the Pilot; Gender, Age, Year in School, Race, Ethnicity, Sexual
Orientation, SES, and Religious Affiliation (n = 21)......................................................100
Table 4
Cronbach Alpha Scores for the Sexual Health Model.....................................................101
Table 5
Descriptive Statistics for Components of the Sexual Health Model................................102
Table 6
Instrument Scoring Method.............................................................................................110
Table 7
Statistical Analyses Summary..........................................................................................111
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CHAPTER 1

INTRODUCTION

Background

The term Sexual Health first was coined by the World Health Organization

(WHO) in 1975 (Edwards and Coleman, 2004). Since its adoption, the term sexual health

has undergone significant changes and continues to be utilized in varied contexts.

According to Edwards and Coleman (2004), the term sexual health has been shaped and

modified by external factors, such as the sexual liberation movement, activist

movements, and issues related to the women’s reproductive freedom. More recently,

Robinson and colleagues (2002) expanded existing definitions of sexual health to propose

one of the most comprehensive definitions to date. The Robinson and colleagues (2002)

definition of sexual health is based on ten different (but not mutually exclusive)

components of human sexuality. These ten components include: “talking about sex (i.e.

values, contraception, etc); culture and sexual identity; sexual anatomy and functioning;

sexual healthcare and safer sex; challenges (overcoming barriers to sexual health); body

image, masturbation and fantasy; positive sexuality; intimacy and relationships; and

spirituality and values” (Bockting et al., 2005, p. 291).

The stage of adolescence, which marks the transition from childhood to

adulthood, can be both an exciting and challenging time in the life of a young person. It is

during this stage in life when individuals go through a series of physical, cognitive,

emotional, social, and behavioral changes that will eventually determine who they are as
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adults (American Psychological Association, 2002). According to the United Nations

Population Fund (UNFPA) (n.d.), adolescence is a time of exploration, education, and

“sexual awakening” (development of self-identity, self-esteem, and comprehensive

thoughts and feelings).

The Centers for Disease Control and Prevention [CDC] (2005a; 2005b) explained

various physical and psychosocial changes that occur during adolescence. In early

adolescence, ages 9-14 (Auslander, Rosenthal, & Blythe, 2006; Kids Growth,

2008; National Campaign to Prevent Teen Pregnancy, 1999), both males and females

undergo physical changes in the body related to puberty (breast bud development, pubic

hair, and hormonal fluctuations). Psychosocially, early adolescents show an increased

concern for physical appearance, often show less fondness and tolerance toward parents,

and will begin to develop critical thinking skills (CDC, 2005a). In middle to late

adolescence, ages 13-21 (Auslander, Rosenthal, & Blythe, 2006; Kids

Growth, 2008; National Campaign to Prevent Teen Pregnancy, 1999), youth begin to

develop their own sense of autonomy and often care less about what others think (CDC,

2005b). Middle to late adolescents will show a deeper interest in being romantically

involved and develop the capacity to have deep, meaningful, and intimate relationships

(CDC, 2005b). Sexuality and sexual exploration (including the ability to engage in a

romantic relationship) are primary objectives and tasks during the adolescent period of

life (State of Oregon, Adolescent Health Section, 2008). During late adolescence, young

people will develop a sense of autonomy (sexually and otherwise) and “sexual identity”.

Further, late adolescents will engage in more “adult” like behaviors including engaging in
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more “complex relationships”, engaging in deep critical thinking, and establishing their

own code of morals/ethics (State of Oregon, Adolescent Health Section, 2008).

Adolescence also is a time when individuals begin to experiment with sexual

behaviors. According to the CDC (2008), Youth Risk Behavior Surveillance Survey

(YRBSS), 64.6% of 12th grade students have engaged in sexual intercourse and 45.8% of

sexually active individuals did not use a condom during their last intercourse. A total of

22.4% of currently sexually active 12th grade students also indicated having had four or

more sexual partners in their lifetime (CDC, 2008). Further, it is estimated that about half

of all adolescents have engaged in oral sexual contact before they reach high school

(Remez, 2000).

In 1991, the National Guidelines Task Force of the Sex Information and

Education Council of the U.S. (SIECUS) identified six life behaviors of a sexually

healthy adult. These behaviors include: “an understanding and appreciation of human

development; developing and maintaining healthy relationships; personal skills;

expressing and enjoying sexual behavior; avoidance of sexual abuse, STD’s, and

pregnancy while practicing health promoting behaviors (termed sexual health); and topics

related to society and culture” (National Guidelines Task Force, 1991, p. 4).

A multitude of variables exist that have the potential to influence sexual health.

Werner-Wilson (1998) stated that sexual attitudes and behaviors are influenced by

internal (biological/psychological) and external factors (relationships and cultural

influences). While both internal and external factors are important, a recent study by the

American Family Association found that, while peers, the media, and religious beliefs

played a large role in an adolescent’s decision to engage in sexual activity, 37% of teens
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stated their parents had the largest influence (AFA Online, 2006). Somers and Surmann

(2004) also found that parents were the preferred source of sexuality information.

Kreinen (2001) stated that children need adults to:

Recognize and validate their particular stage of sexuality, give them age-

appropriate information about sexuality, share their values in the context of

competing values in the surrounding culture, create a safe, healthy environment

by stating and reinforcing age appropriate rules, and teach them [children] how to

handle potentially harmful situations and make responsible and healthy choices on

their own (p. 3).

Further, Cappello (2001) stated that the role of parents in developing sexual health in

adolescents is important due to the fact that only parents can share values and beliefs

related to sexuality that are unique to that particular family.

Statement of the Problem

Although the role of parents in influencing sexual health is becoming more

important in a society where adolescents are bombarded with sexual messages (e.g.

billboards, ads, television, and cinema), parents are finding themselves unable or

unprepared to discuss sexuality related topics with their children (Cappello, 2001). In

terms of parents as sexuality educators, “we hear that they often do not know when or

how to start these [sexuality] conversations, that they feel ill-equipped to handle

discussions, and that even those parents who are talking to their children about sexuality

are not spending enough time on these issues” (Kreinen, 2001, p. 3). Further, Davis and

Friel (2001) revealed that many parents who do discuss sexuality related issues with their

children do so after the young person has already begun engaging in sexual behaviors.
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Jaccard, Dittus, and Gordon (1998) described parental communication as having

five dimensions including, “(1) the extent of communication (measured in terms of

frequency and depth), (2) the style or manner in which information is communicated, (3)

the content of the information that is communicated, (4) the timing of the

communication, and (5) the general family environment (i.e. the overall quality of the

relationship between parent and teen) in which the communication takes place” (p. 247).

Any dimension of parent-adolescent communication has the potential to either

positively or negatively influence future sexual health. Studies indicated that parent-

adolescent sexuality-based communication is more successful in terms of promoting

safe/healthy sexual outcomes when it is conducted in a friendly, open, and supportive

environment (Miller, Kotchick, Dorsey, Forehand & Ham, 1998; Mueller & Powers,

1990). Unfortunately, parent-adolescent sexuality-based communication does not always

occur in such a supportive and open nature. Feldman and Rosenthal (2000) stated , “in

observational studies, maternal communications about sex and sexuality, compared to

communications about other topics, are indirect, involve more dominance and unilateral

power assertion, less mutuality and turn taking, and lower levels of comfort, whereas

adolescent communications involve more contempt, less honesty, and more avoidance”

(p. 122). This dominating and pessimistic form of communication has the potential to

negatively influence future sexuality-based communication, positive sexuality, intimacy,

and other aspects of positive sexual health. As explained by Whitaker, Miller, May and

Levin (1999), “a discussion that consists solely of a parent's demanding that a child

refrain from having sex may send a message that everything about sex is to be avoided,

and may thus suppress the teenager's desire to discuss sex with a partner” (p. 118).
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Another example, related to the content and depth of communicated information,

lies in what aspects of sexuality are discussed between parents and adolescents. Those

parents who make an effort to talk about sexuality-related topics with their children often

provide inaccurate information and only discuss a selected number of topics, therefore

leaving out key components of sexual health. Jordan, Price, and Fitzgerald (2000)

indicated that there are several topics related to sexual health that are never discussed by

parents. This study found that topics, such as masturbation, pornography, and abortion

rarely were (if ever) discussed between parents and adolescents (Jordan, Price, &

Fitzgerald, 2000). Further, a study by Guiliamo-Ramos, Dittus, Jaccard, Goldberg,

Casilass, and Bouris (2006) found that communication between parents and their children

depended on their children’s gender. Parental communication with girls tended to be

related to saving one’s self before marriage (virginity) and purity, while parents discussed

safe sex with males (Guiliamo-Ramos et al., 2006). This expression of communication

(altering information depending on the sex of the adolescent) showed both a lack of

potentially lifesaving information for females and a possibly dominating and one-sided

conversation between mothers and their daughters, which may not be conducive to

positive sexual health.

Need for the Study

The majority of existing studies related to parental communication have focused

solely on behavioral outcomes of parent-adolescent communication, such as increased

use of contraceptives, prolonging initiation of first sexual activity, and decreasing the

number of sexual partners. These studies have yielded inconclusive results, with some

indicating a positive influence of parental communication on sexual behavior and others


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concluding that parental communication encouraged or was ineffective in altering sexual

behavior. Studies that have shown a positive influence on sexual behavior indicated that

parents who discussed sexuality-related issues with their adolescents were more likely to

have children who used contraceptives during intercourse (Hutchinson, 2002; Romer,

Stanton, Galbraith, Feigalman, & Li, 1999), discussed sexuality with their future partners

(Whitaker, Miller, May, & Levin, 1999), and delayed sexual intercourse (Hutchinson,

2002; Lederman & Mian, 2003). However, other studies have found that parental

communication had little effect on adolescent sexual activity (Fisher, 1993; Newcomer &

Udry, 1985)

Few studies have focused on the effects of parental communication on other

aspects of complete sexual health, such as body image, fantasy, positive sexuality, and

other items described by Robinson and colleagues (2002) or those discussed in Bockting

et al. (2005). Thus, the influence of parental-communication on these areas of sexual

health is poorly understood. The current predicament (and possible ethical dilemma) lies

in the fact that health and sexuality educators/professionals (such as SIECUS) are

endorsing and promoting parents as sexuality educators without a complete

understanding of the possible future implications. In other words, health educators are

telling parents that sexual communication is important, without understanding the effects

on total sexual health. Health educators also are not informing parents about how to

communicate in a way that is conducive to positive, total sexual health. Understanding

the role of parental communication in sexual health development is crucial if health

educators desire to promote and foster sexually healthy adults. Facilitating sexual

development through parental communication includes providing parents with the


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information and skills necessary to promote positive sexual health in their children. This

study will add to the existing literature about the influence of parent-adolescent

communication on sexuality as well as helping parents/guardians understand which

aspects of communication are positively correlated with affirmative sexual health.

One of the possible reasons that studies on parental-communication have been

limited to assessing the impact of communication on behavior has been the lack of an

adequate/reliable tool that assesses all areas of sexual health. Recently, an instrument

assessing all ten areas of sexual health as described by Bockting et al. (2005) has been

developed by Edwards, Coleman, and Miner (2007) from the University of Minnesota

Medical School.

Significance to Health Education

Human sexuality is a natural part of life and an essential part of health and

wellness. SIECUS has established a set of values related to sexuality including (but not

limited to): “all persons are sexual, sexuality includes physical, ethical, spiritual,

psychological, and emotional dimensions, individuals express sexuality in varied ways,

individuals and society benefit when children are able to discuss sexuality with their

parents and/or other trusted adults, and young people explore their sexuality as a natural

process of achieving sexual maturity” (National Guidelines Task Force, 1991, p. 5).

Sexual health, like all other dimensions of health and wellness, requires assistance and

support during the developmental stages of life, if parents and health educators wish to

cultivate healthy and productive adults (according to the SIECUS standards/guidelines).

Adolescence is the time where young people develop attributes that will increase

the likelihood that they will become sexually healthy adults, including (but not limited to)
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the development of sexual identity, what it means to be engaged in a “serious”

relationship, and the development of “the capacity for tender and sensual love” (Kids

Growth, 2008). The American Psychological Association (2002) emphasized the need of

parents to “prepare their children early for the changes of adolescents” as having a

supportive parent can positively impact a child, both sexually and otherwise.

As sexuality is an essential aspect of being for both adolescents and adults, it is

imperative that health educators understand the aspects of sexuality-based parent-

adolescent communication that are conducive to positive sexual health. Implications of

developing positive sexual health include enhancing the ability of adolescents to discuss

sex with parents and future partners; strengthening sexual identity (developed during

adolescents); fostering positive sexual behavioral outcomes, improving the ability of

adolescents to overcome barriers to positive sexual health; cultivating a more positive

body image; understanding familial and religious position on masturbation and fantasy,

positive sexuality; cultivating a more positive and intimate relationships; and helping

adolescents understand how spiritual and familial values play a role in their sexuality

(Bockting et al., 2005).

In terms of understanding the role of sexuality-based parent-adolescent

communication in behavioral outcomes, this study will help health educators address

professional goals and the ever increasing threat of sexually transmitted infections

(STI’s). Beginning in 1979, the U.S. government published a series of national health

goals, known as the Healthy People documents. Currently, two primary health-related

goals for the nation include: (1) increase quality and years of healthy life and (2)

eliminate health disparities (U.S. Department of Health and Human Services, 2000).
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These primary goals are monitored by a series of objectives and focus areas. Cited in

Healthy People 2010, health communication and sexually transmitted diseases (STD’s)

have been identified as two of the 28 health related focus areas (U.S. Department of

Health and Human Services, 2000). Consistent with Healthy People 2010, the document

Healthy Campus 2010 was devised to be a “companion document” to institute national

health goals/objectives within the college age population (American College Health

Association, n.d). This document identified responsible sexual behavior among the

leading health indicators (American College Health Association, n.d.). Understanding the

early influences on sexual health will assist health educators in reaching the sexuality

related objectives of both Healthy People 2010 and Healthy Campus 2010.

The National Surveillance Data on Chlamydia, Gonorrhea, and Syphilis reported

by the CDC (2007), indicated that 19 million new cases of STI’s occur every year, with

almost half of these cases occurring among young people, ages 15-24. Many more cases

of STI’s go undiagnosed and some (including Human Papilloma Virus) often go

unreported (CDC, 2007). Regarding STI rates in the state of Illinois, the Illinois

Department of Public Health STI Epidemiologic Summary Report found that between

1992 and 2002, 33% of Chlamydia cases occurred in young people, ages 15-19, with the

average age of a Chlamydia patient being 23 years (Illinois Department of Public Health,

2004). Gonorrhea cases were highest among ages 15-24 years (61% of all reported cases

during 2001) (Illinois Department of Public Health, 2004). “The case rate for adolescents,

ages 15-19, was 731.8/100,000 compared to 193.5/100,000 for the total Illinois

population” (Illinois Department of Public Health, 2004, p. 17). These STI’s present a

myriad of potential problems, including further transmission due to asymptomatic


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conditions, emotional/physical trauma, infertility, cancer, and death. Sexual healthcare

(including safer sex) has been identified by Bockting et al. (2005) as one of the ten areas

of sexual health. Understanding the correlation between parental communication and

overall sexual health will help health educators recognize the role parents play in

developing attitudes and practices that are conducive to safe sexual practices.

Purpose of the Study

The purpose of this study is to examine the relationship between parent-

adolescent, sexuality-based communication and sexual health among selected

undergraduate students at a large, mid-western university. The areas of sexual health to

be assessed are those described by Bockting et al. (2005) including talking about sex,

culture and sexual identity, sexual anatomy and functioning, sexual health care and safer

sex, overcoming barriers to sexual health, body image, masturbation and fantasy, positive

sexuality, intimacy and relationships, and spirituality and values. The dimensions of

parental communication to be assessed include the selected dimensions described by

Jaccard, Dittus, and Gordon (1998) including, (1) the style or manner in which

information is communicated, and (2) the general family environment (i.e. the overall

quality of the relationship between parent and teen) in which the communication takes

place). While Jaccard, Dittus, and Gordon (1998) do not give a specific definition to

“style and manner” of communication, for the purpose of this study, style and manner

will refer to the openness and receptiveness of communication. The other dimensions of

communication described by Jaccard, Dittus, and Gordon (1998) (i.e. the extent of

communication, the content of the information that is communicated, and the timing of

the communication) already have been extensively researched. Although the relationship
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between these dimensions of communication and overall sexual health has not been

established, existing constraints do not allow their application in this study.

Research Questions

1) What is the overall level of sexual health among selected undergraduate students?

2) What is the level of parent-adolescent sexuality-based communication of selected

undergraduate students?

3) Do differences exist in reported sexuality-based parent-adolescent communication

among selected undergraduate students based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

4) Do differences exist in sexual health based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

5) What is the relationship between the style and manner of sexuality-based parental

communication and levels of sexual health?

6) What is the relationship between the general family environment and sexual health?

7) How much variance in overall sexual health can be explained by selected dimensions

of parent-adolescent communication?

Research Design

A descriptive, cross-sectional, correlational design will be employed in this study.

According to Isaac & Michael (1995), descriptive studies are used, “to describe

systematically a situation or area of interest factually and accurately” (p. 46).

Correlational studies are used, “to investigate the extent to which variations in one factor

correspond with variations in one or more other factors based on correlation coefficients”

(p. 46). This study will be focusing on how selected dimensions of parent-adolescent
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communication correspond with sexual health. Thus, a correlational design is

appropriate.

Data Collection

The study sample will include a non-random, convenience sample of

undergraduate, male and female students, ages 18-22. This sample was chosen because

this group represents a population who (by this age) should be close to completing sexual

development stages occurring during the period of adolescence, yet are young enough to

recall sexuality-based parental communication. Instruments will be distributed (upon

permission) to students attending selected undergraduate courses at a large, mid-western

university.

The instrument used to assess sexual health, termed the Sexual Health Inventory,

was developed by Edwards, Coleman, and Miner (2007). The instrument is comprised of

112 items assessing demographic variables, the ten areas of sexual health, and 32 sub-

components. Items assessing sexual health consist of five-point, Likert-type scale items,

originally used by the instrument developers.

The instrument used to assess parental communication (Parental Communication

Assessment Survey) contains two components; one assessing the style or manner in which

information is communicated and another assessing the general family environment (i.e.

the overall quality of the relationship between parent and teen) in which the

communication takes place). The scale assessing style and manner of communication

previously was used by Miller, Kotchick, Dorsey, Forehand and Ham (1998) and Dutra,

Miller, and Forehand (1999). The scale consists of 10, five-point Likert-type scale items,

assessing the openness and receptiveness of communication. The portion of the


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instrument assessing general family environment was developed by Jaccard, Dittus, and

Gordon (2000) and assesses the satisfaction of the relationship from the standpoint of the

participant. The scale consists of 11, five-point Likert-type scale items. Participants will

be asked to complete each communication scale separately for mothers and fathers (or

appropriate legal guardian). Items assessing demographics will be placed at the end of the

instrument.

Data Analyses

Descriptive statistics, including frequencies, percentages, and measures of central

tendency and dispersion will be used to describe parental communication and sexual

health. To assess differences in reported sexuality-based parental communication and

sexual health based on gender, socio-economic status, race/ethnicity, sexual orientation,

and religious affiliation; independent sample t-tests and analysis of variances

(ANOVA’s) will be conducted. Pearson correlations will be calculated to examine

relationships between selected dimensions of parent-adolescent communication and

sexual health. Finally, a multiple regression analysis will be conducted to test how much

variance in sexual health can be explained by the selected dimensions of communication.

Assumptions

1) Sexual health is a measurable concept.

2) Participants’ responses will be honest and accurate.

3) Participants will be able to adequately recall sexuality based parent-adolescent

communications.

4) Participants enrolled in health education courses are similar to other students at SIUC.
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Limitations

1) The sample for this study is one of convenience. Therefore, the ability to generalize

the results will be limited.

2) Study results will be affected due to the fact that subjects are required to recall past

events.

3) Due to the length of the instrument, participants may not complete all items or may

skip items or mark inappropriate responses quickly to complete the instrument

4) Due to the sensitive nature of the topic, participants may hesitate to answer truthfully.

5) Time and financial constraints do not allow for a more thorough study.

Delimitations

1) A single university will be studied.

2) Students will be recruited from selected undergraduate courses

3) The study will be limited to students, undergraduate ages 18-22.

4) This study will examine sexual health, as defined by Robinson and colleagues (2002),

parent-adolescent communication, and selected demographics.

Definitions

• Sexual Health Model: A constituent of overall health consisting of ten components

including: “talking about sex (i.e. values, contraception, etc); culture and sexual

identity; sexual anatomy and functioning; sexual healthcare and safer sex; challenges

(overcoming barriers to sexual health); body image, masturbation and fantasy;

positive sexuality; intimacy and relationships; and spirituality & values” (Bockting et

al., 2005, p. 291).


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• Adolescent – While no standard definition of ‘adolescence’ exists, the National

Institutes of Health (2007) and the American Psychological Association (2002)

concur that adolescence begins between 10-12 years of age and continues until 18

years of age. However, the American Psychological Association (2002)

acknowledged that the period of adolescence may continue until 25 years of age.

• Sexuality Based Parent-Adolescent Communication – Any verbal messages

transmitted from parent/guardian to an adolescent, concerning any aspect of sexual

health.

• Parent – The biological mother, father (or both) or legally appointed guardian

responsible for raising the adolescent participant.

• Style and Manner [of communication] – Refers the openness and receptiveness of

sexuality based, parent-adolescents communication

Summary

Adolescence is a time of growth, exploration, and development and requires

assistance from appropriate adult mentors; the development of sexual health is no

exception. The term Sexual Health as we understand it today comprises more than just

the physical act of intercourse and includes several aspects of human sexuality. One of

the many ways parents foster the development of sexual health is through the use of

communication, of which there are dimensions. The purpose of this study is to examine

the relationship between two selected dimensions of communication (quality of the

parent-adolescent relationship and the style/manner of communication) and sexual health.

The results of this study will assist health educators in not only curbing the negative

outcomes of adolescent sexual behavior, but also provide information on how to talk to
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foster proper sexual health. Further, the results of this study will help address the

requirements of both Healthy People 2010 and Healthy Campus 2010. Chapter 2 will

provide an extensive review of the literature related to communication, sexual health, and

factors associated thereof.


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CHAPTER 2

REVIEW OF THE LITERATURE

Overview

This chapter provides an extensive overview of the existing literature related to

sexual health and parent-adolescent communication. Further, this chapter will provide

literature showing the need for this study and more studies related to complete sexual

health. Specific topics to be covered in this chapter include: adolescent development;

defining Sexual Health; adolescent sexual behavior; general communication; the role of

parents in sexuality education; factors related to communication; variables of sexuality-

based communication; outcomes of parent-adolescent communication; and other

influences on adolescent sexual health.

Purpose of the Study

The purpose of this study is to analyze the relationship between parent-adolescent,

sexuality-based communication and sexual health among selected undergraduate students

at a large, mid-western university.

Research Questions

1) What is the overall level of sexual health among selected undergraduate students?

2) What is the level of parent-adolescent sexuality-based communication of selected

undergraduate students?
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3) Do differences exist in reported sexuality-based parent-adolescent communication

among selected undergraduate students based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

4) Do differences exist in sexual health based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

5) What is the relationship between the style and manner of sexuality-based parental

communication and levels of sexual health?

6) What is the relationship between the general family environment and sexual health?

7) How much variance in overall sexual health can be explained by selected dimensions

of parent-adolescent communication?

Adolescent Development

To date, no standard definition for the term ‘adolescence’ exists

(American Psychological Association, 2002). Current definitions place

the period of adolescence between ten years of age, extending to a

person’s early 20’s (Auslander, Rosenthal, & Blythe, 2006; American

Psychological Association, 2002; National Institutes of Health, 2007).

However, the American Psychological Association (2002) and the

National Institutes of Health (2007) shared that the period of adolescence is

most commonly placed between ten and 12 years of age, extending to

18 years of age. Although there is no current standard definition of

adolescence, adolescence is typically broken into three phases; early,

middle and late adolescence (Auslander, Rosenthal, & Blythe, 2006;

Kids Growth, 2008; National Campaign to Prevent Teen Pregnancy, 1999). During
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each of these stages, adolescents undergo a variety of physical,

psychological, and emotional changes, will develop their sexual

identity, and learn what it means to be involved in an intimate

relationship with another person (Auslander, Rosenthal & Blythe,

2006). However, no standard age range is given for each of these

stages. Perkins (2001) identified four major questions that adolescents

will ask themselves during this developmental period of life; they

include: Who am I? Am I Normal? Am I competent? and Am I Loveable

and Loving? Kaufman (2006) and the National Campaign to Prevent Teen Pregnancy

(1999) discussed the various physical and psychosocial, non-continuous stages of

adolescent development that a young person will go through while he/she attempt to

answer the questions identified by Perkins (2001).

First, sexual development has been identified as a significant

developmental process in the life of an adolescent (Kaufman, 2006;

Kids Growth, 2008; National Campaign to Prevent Teen Pregnancy, 1999). The

National Guidelines Task Force (1991) confirmed the importance of sexual development

and proper exploratory sexual behavior by stating that it is natural for adolescents to

explore their sexuality as they develop and that such exploration is necessary for

“achieving sexual maturity” (p. 5). Sexual development in terms of

physical/sexual maturation includes the movement from emphasis on

physical appearance to accepting and being happy with one’s body

image (The National Campaign to Prevent Teen Pregnancy, 1999). However,

sexual development involves much more than the physical aspect.


Parent-Adolescent Communication
about Sex 25
Auslander, Rosenthal, and Blythe (2006) added to Kaufman’s

description of sexual development by explaining the sexual/intimate

attitudes and behavior of adolescents during each developmental

phase of adolescent span. During early adolescents, when peer

acceptance and emphasis on physical appearance are at their peak,

young people will begin to experience and attempt to understand the

plethora of feelings, emotions, and behaviors that come along with

being in an intimate relationship and living as a sexual person in

general (Auslander, Rosenthal, & Blythe, 2006; Kids Growth, 2008).

Further, adolescents at this stage will typically seek approval of their

social peers as to what types of relationship and sexual behaviors are

acceptable (Auslander, Rosenthal, & Blythe, 2006; National Campaign to

Prevent Teen Pregnancy, 1999). Intimate relationships during early

adolescence tend to be short lived, non-monogamous in nature, and

not typically conducted in a one-on-one situation, but rather in the

setting of groups (American Academy of Child and Adolescent

Psychiatry, 2008; Auslander, Rosenthal, & Blythe, 2006). As young

people age and move on to later stages of development, they typically

become more sexually experienced, develop a greater set of skills,

understand deeper emotions related to sexuality, and understand

factors involved in deeper intimate relationships (Auslander, Rosenthal,

& Blythe, 2006; National Campaign to Prevent Teen Pregnancy, 1999). Such skills

include the importance of give and take in a relationship, the ability to


Parent-Adolescent Communication
about Sex 26
commit to one person, the sharing of feelings and information, and the

art of problem solving (Auslander, Rosenthal, & Blythe, 2006).

The next stage, cognitive development, involves the ability of the adolescent to

disengage from concrete thinking, which is prevalent in early adolescents, and develop

conceptual/abstract thinking, occurring in middle and late adolescents (Kaufman, 2006;

National Campaign to Prevent Teen Pregnancy, 1999). Concrete thinkers can be

described as individuals who see things as one way or another with little room or

acceptability of gray areas (Kaufman, 2006). Individuals who are concrete

thinkers also have a problem assessing and comprehending

consequences of their actions because they fail to see any changes

from reality in the future (i.e. interpreting today’s reality as what will

always be) or simply live for the moment (American Academy of Child

and Adolescent Psychiatry, 2008; Kaufman, 2006; National Campaign to

Prevent Teen Pregnancy, 1999). The living for the moment mentality is evidenced by

youth commonly feeling as if they are invincible or as if everything that possibly could

go wrong only happens to other individuals and not themselves (Kids Growth, 2008).

Further, adolescents often have a difficult time understanding cause and effect within

relationships (i.e. understanding the relationship between sexual risk taking and STI’s)

(Kids Growth, 2008). While the development of abstract thinking is

fostered within the school system (Kaufman, 2006), the significance to

parent-adolescent sexuality-based communication lies in parents

helping their children understand the negative implications of


Parent-Adolescent Communication
about Sex 27
engaging in unsafe sexual practices (i.e. STI’s, unplanned pregnancy,

etc).

During emotional development, adolescents learn to understand

and interpret different emotions (Kaufman, 2006). Adolescents begin

to wonder if they are normal (sexually and otherwise), with which

comes an array of distressing emotions (Perkins, 2001). For example,

adolescents may worry about whether they are physically developing

at the same rate as peers or have “concerns regarding physical and

sexual attraction to others” (American Academy of Child and

Adolescent Psychiatry, 2008). Also related to emotional development,

adolescents also will ask themselves if they are capable of being loved

(unconditionally) (Perkins, 2001). Attempting to understand complex

emotions can be an extremely trying time in the life of an adolescent

and can be made more difficult if parents do not foster the exploration

of feelings in a healthy manner. Parents who continuously assume they

know what their child is going through or how their children should feel

in a given situation or circumstance may foster adolescents who

believe that their feelings are not legitimate (Kaufman, 2006). Studies

related to sexuality indicated that parents (mothers in particular) tend

to dominate discussions and force their own viewpoints, ways of

thinking, or their own understanding of their children upon the

adolescent. Rosenthal, Senserrick, and Feldman (2001) shared that

adolescents typically rate their parents as futile, challenging, and


Parent-Adolescent Communication
about Sex 28
uncomfortable communicators. During the period of adolescence,

when youth are experiencing complex emotions related to love and

intimacy, it is of utmost importance that parents acknowledge their

status and foster them through the process in a way that is open and

conducive to the emotional well-being of the adolescent.

During the developmental stage termed identity development,

adolescents become self-aware and begin to understand how their

thoughts, feelings, and points of view are different from their parents

(Kaufman, 2006). The National Campaign to Prevent Teen Pregnancy (1999),

grouped identity development with emotional development, but also

described this stage as a period of “independent decision-making.”

During this time, adolescents may be deemed as confrontational, as

many will attempt to disassociate themselves from parents in all ways

and frequently disagree or quarrel with parents on issues related to

opposing viewpoints (American Academy of Child and Adolescent

Psychiatry, 2008; Kids Growth, 2008). Similar to emotional

development, parents have the ability to either foster or hinder the

development of identity. While it is important for adolescents to be

given rules and boundaries, as the implementation thereof provides a

frontier in which to operate, many parents do not adequately

communicate these regulations to their children (Kaufman, 2006).

When regulations are unyielding or limitless, adolescents may either

run wild or continue pushing limits in an attempt to express


Parent-Adolescent Communication
about Sex 29
themselves. In either case, both inadequately setting boundaries and

setting boundaries that are overly stringent do not promote proper

exploration and expression of identity (Kaufman, 2006). The limits put

on an adolescent in terms of sexuality have multiple implications for

parent-adolescent conversations. During parent-adolescent

conversations regarding sexual issues, it is not uncommon for parents

to place limits on adolescents in regards to what sexual behaviors are

considered acceptable (parental approval/disapproval of sexual

behavior) or perhaps whether or not the parent approves of

contraceptive use. Parents who express rigid, excessive demands or points of view

on an adolescent may foster non-conformative behavior. Parents who place severe and

stringent restraint on an adolescent may actually encourage risky sexual behavior (Miller,

1998). It also is possible that parents who highlight traditionalist behavior may hinder

future, productive, healthy sexual communication.

Related to the development of identity is the development of

autonomy during the adolescent years. Kaufman (2001) and the

National Campaign to Prevent Teen Pregnancy (1999) explained autonomy in

terms of independence, whereby an adolescent will assume control

over their own actions, decisions, and overall care. A person’s level of

autonomy develops from early adolescence where peers greatly

influence the decision making process to late adolescence where peer

and other outside influence (i.e. families) are taken into consideration

(National Campaign to Prevent Teen Pregnancy, 1999). However, during late


Parent-Adolescent Communication
about Sex 30
adolescents when critical thinking skills are becoming more

development, young people are more capable of sorting through

influences in order to make their own decisions (National Campaign to

Prevent Teen Pregnancy, 1999).The Pan American Health Organization and

the World Health Organization (2000) published a document that

discussed the concept of Sexual Autonomy, whereby a person has the

right to make “autonomous decisions” about their sexual health (p.

37). These autonomous decisions infer decisions made about sexual

practices and having the ability to develop one’s own opinion and

viewpoint on various sexual issues. While adolescents continue to seek

autonomy and independence from parents, they continue to require

connection and intimacy from their families (Callan & Noller, 1986).

Parents have the ability to foster sexual autonomy by allowing

adolescents to express their own perspectives and wishes in regards to

various sexual issues. As is with the general concept of autonomy,

which the development thereof is important for progressing to

adulthood, allowing adolescents the right to hold and express their

beliefs about sexuality has the potential to foster a sexually healthy

adult and foster future communication. Unfortunately, many parents

discuss sexuality in a one-sided, dominant manner or lecture that does

not permit open communication that would allow the adolescent to

express their points of view (Kahlbaugh, Lefkowitz, Valdez, & Sigman, 1997;

Fitzharris & Werner-Wilson, 2004)


Parent-Adolescent Communication
about Sex 31
Sexual Health Defined: The Sexual Health Model

The term ‘sexual health’ has undergone decades of revisions, fueled by a

combination of political activism, social reform, and trends in schools of thought in areas

of human sexuality (Edwards & Coleman, 2004). The original definition of sexual health

came from the 1975 World Health Organization (WHO) meeting in Geneva (World

Health Organization, 1975). Understanding that human sexuality played a wider role in

overall health and wellness than previously recognized, WHO deemed it important to

step back and assess how sexuality should be taught and implemented into appropriate

programs (i.e. counseling) (World Health Organization, 1975). Thus, it was important to

define sexual health before it could be used in practical manner. WHO defined sexual

health as, “the integration of the somatic, emotional, intellectual and social aspects of

sexual being, in ways that are positively enriching and that enhance personality,

communication and love” (World Health Organization, 1975). “The WHO definition of

sexual health contains aspects that have been used as a basis for subsequent definitions”

(Edwards & Coleman, 2004, p. 191). These components include the ability to

enjoy/control sex, the ability to enjoy sex without psychological trauma (i.e. fear or guilt)

and the ability to experience proper sexual functioning (World Health Organization,

1975; Edwards & Coleman, 2004). Subsequent meetings addressing the definition of

sexual health revealed that many individuals desired additional components. For instance,

the International Conference on Population and Development (ICPD) included sexual

health in their definition of reproductive health, which included aspects relationship

enrichment and aspects of having access to birth control and relevant contraception

information (World Health Organization, 2002a). The succeeding definition, developed


Parent-Adolescent Communication
about Sex 32
by SIECUS in 1995, further added to the definition by adding the components of

love/intimacy, values, relationships, and mutual respect between genders (Edwards &

Coleman, 2004; National Commission on Adolescent Sexual Health, 1995). The latest

definition of sexual health comes from WHO:

Sexual health is a state of physical, emotional, mental and social well-being

related to sexuality; it is not merely the absence of disease, dysfunction or

infirmity. Sexual health requires a positive and respectful approach to sexuality

and sexual relationships, as well as the possibility of having pleasurable and safe

sexual experiences, free of coercion, discrimination and violence. For sexual

health to be attained and maintained, the sexual rights of all persons must be

respected, protected and fulfilled (World Health Organization, 2002b).

The Sexual Health Model (SHM), described by Robinson et al. (2002), was

developed to address the need to encompass various aspects of human sexuality beyond

the physical realm, such as “relational and emotional” variables (p.44). Robinson and

colleagues (2002) used the following definition of sexual health as the basis of the SHM:

Sexual health is an approach to sexuality founded in accurate knowledge, personal

awareness, and self-acceptance, such as one’s behavior, values and emotions are

congruent and integrated within a person’s wider personality structure and self-

definition. Sexual health involves the ability to be intimate with a partner, to

communicate explicitly, about sexual needs and desires, to become sexually

functional (to have desire, become aroused, and obtain sexual fulfillment), to act

intentionally and responsibly, and to set appropriate sexual boundaries. Sexual

health has a communal aspect reflecting not only self-acceptance and respect, but
Parent-Adolescent Communication
about Sex 33
also respect and appreciation for individual differences and diversity, as well as a

feeling of belonging to and involvement in one’s sexual culture(s). Sexual health

includes a sense of self-esteem, personal attractiveness, and competence, as well

as freedom from sexual dysfunction, sexually transmitted diseases, and sexual

assault and coercion. Sexual health affirms sexuality as a positive force,

enhancing other dimensions of one’s life (Robinson et al, 2002, p. 45).

The SHM was developed using three sources: “(1) key characteristics of an

established sexological approach to comprehensive sexuality education; (2) literature-

based recommendations for culturally specific, relevant, normative models of sexual

health derived from the target’s community’s experience, and (3) qualitative and

quantitative research on sexual attitudes, practices, and risk factors of various

populations, as well as their context for safer-sex decision making” (Robinson et al.,

2002, p. 45). The final model included ten components: talking about sex, culture and

sexual identity, sexual anatomy and functioning, sexual health care and safer sex,

overcoming barriers to sexual health, body image, masturbation and fantasy, positive

sexuality, intimacy and relationships, and spirituality and values (Bockting et al. 2005).

While the SHM may not encompass the most recent definition of sexual health, the

Robinson et al. (2002) SHM was used for this study because it was the model used to

develop the instrument to assess sexual health and because its vigor lies in the fact that it

is an extremely encompassing definition. The definition was found to encompass all

aspects of human sexuality (including the physical and psychosocial components) as well

as aspects of overall health and wellness.


Parent-Adolescent Communication
about Sex 34
Whatever the definition, the role of sexual health and sexuality in our lives cannot

be disputed. WHO summed up the importance of sexual health in a 1986 document

which declared, “sexuality is an integral part of the personality of everyone: man,

woman, and child. It is a basic need and an aspect of being human that cannot be

separated from other aspects of human life” (Coleman, 2002, p. 3).

Adolescence is the time where young people will develop attributes, with which

they will carry into adulthood. In terms of sexuality, adolescents who are unable (for

whatever reason) to adequately go through sexual development stages risk hindering

future intimate relationships in adulthood (National Institutes of Health, 2008). SIECUS

identified six life behaviors of a sexually healthy adult, which include, “an understanding

and appreciation of human development; developing and maintaining healthy

relationships; personal skills; expressing and enjoying sexual behavior; avoidance of

sexual abuse, STD’s, and pregnancy while practicing health promoting behaviors (termed

sexual health); and topics related to society and culture” (National Guidelines Task

Force, 1991, p. 4). Sexual health, like all other aspects of health and wellness, requires

mentoring and fostering if it is desired to generate sexually healthy adults. A host of

factors play a role in the development of a sexually healthy adult including familial and

external variables.

Adolescent Sexual Behavior

While the process of sexual development and sexual health as a

whole is a natural and essential aspect of being, the outcomes of

adolescents engaging in sexual activity have implications for both the

individuals involved and the society at large. Adolescents who engage


Parent-Adolescent Communication
about Sex 35
in sexual activity risk a number of both physical and emotional strains

due to unwanted outcomes. Such unwanted outcomes include physical

trauma from STI’s, financial burden from unplanned pregnancies, and

the intense emotions related to engaging in sexual intercourse. In

terms of the burden to society, the CDC (2006) acknowledged that the

medical costs associated with STI’s in the United States reached a total

of 14.7 billion dollars, with many of the current STI’s affecting the

adolescent population.

Results from the 2007 Youth Risk Behavior Survey, conducted by

the CDC, indicated several alarming trends in adolescent sexual

activity. Almost half (47.8%) of students in grades 9-12 had had sexual

intercourse at some point in time before the survey, with 14.9% of

currently sexually active adolescents having done so with four or more

partners (CDC, 2008). A total of 35% of all adolescents reported

engaging in sexual intercourse with at least one person in the last

three months, indicating recent sexual activity (CDC, 2008). Many

adolescents are throwing caution to the wind in terms of engaging in

risky sexual behaviors. A total of 61.5% of currently sexually active

adolescents used a condom during their last intercourse and 22.5% of

currently sexually active adolescents used alcohol or another mind

altering substance before engaging in their last intercourse (CDC,

2008). Many adolescents also have been shown to engage in non-

coital sexual activities that carry potentially harmful risks. Almost 20%
Parent-Adolescent Communication
about Sex 36
of 9th graders have engaged in oral sex, believing it is less risky that

vaginal intercourse (Halpern-Felsher, Cornell, Kropp, & Tschann, 2005).

Many of these adolescents (31.5%) indicated they intend to engage in

oral sex in the near future (next six months) (Halpern-Felsher, et al.,

2005). Sexual behaviors put adolescents at an increased risk for

unwanted outcomes such as STI’s and pregnancy. Current STI rates are

highest among adolescents and young adults, with almost half of the

19 million new infections every year occurring among those ages 15-

24 (CDC, 2006). The Guttmacher Institute (2006) found that 750,000

women, ages 15-19, give birth every year. Single (never married)

women in particular reported an extremely high level of unintended

pregnancies (77% of all pregnancies nationwide) (State of Minnesota,

2002). Nationally, 49% of all pregnancies (to married and unmarried

women) were unintended (Finer & Henshaw, 2006). The state of

Michigan alone, which experienced 26,000 unintended pregnancies in

2001, spent $260,000,000 on delivery, pre-natal, and post-natal care

(State of Michigan, n.d.). In another example, in the state of Minnesota, “in 2001,

there were 18,553 subsidized deliveries at an average cost of $3,386 for a total of

$62,819,540. There were 22,144 recipients of first year services at a cost of $6,894 for a

total of $152,669,942. If half of those pregnancies were unintended, the estimated cost

for births and first year services from pregnancies begun without planning or intent is

$107,744,741” (State of Minnesota, 2002, p. 1). Further, an estimation of cost to

raise a child to the age of 18 showed that it will cost a two-parent family $130,000
Parent-Adolescent Communication
about Sex 37
- $241,000 and a one parent-family approximately $123,000 -

$143,000 (State of Michigan, n.d.). Besides the financial burden to the

adolescent (and most likely his/her family), unplanned children are

more at risk for physical abuse, not attaining educational goals, be

born prematurely, and are more likely to be neglected (State of

Michigan, n.d.).

The Roll of Parents in the Sexual Development of Adolescents

Initially, individuals begin learning about sexuality as toddlers, when their parents

dress them in gender appropriate clothing, play with them in different ways (i.e. rough

play for male toddlers as opposed to being more gentile with girls), and show affection

(SIECUS, 2001). As we grow and mature, parents help shape attitudes about sexuality

and provide information/communication about sexuality and sexual behaviors. Children

need adults to:

Recognize and validate their particular stage of sexuality, give them age-

appropriate information about sexuality, share their values in the context of

competing values in the surrounding culture, create a safe, healthy environment

by stating and reinforcing age appropriate rules, and teach them [children] how to

handle potentially harmful situations and make responsible and healthy choices on

their own (Kreinen, 2001, p. 3).

Parents and other family members also are essential in the lives of adolescents for not

only fostering them through the developmental stages of life, but for providing structure

and addressing psychosocial needs (Callan & Noller, 1986)


Parent-Adolescent Communication
about Sex 38
While parents may be the primary mentor(s), with 51% of adolescents in one

study identifying their mothers and 5% indicating their father as the primary mentor, the

importance of an adult mentor in general in the lives of adolescents is extremely valuable

in terms of curbing risky sexual behavior (Beier, Rosenfeld, Spitalny, Zansky, &

Bontempo, 2000). More specifically, those adolescents who reported having mentors

were less likely to have recently engaged in sexual intercourse with more than one person

(Beier et al., 2000). Considering the role of parents in the development of

adolescent sexual health, one of the primary ways parents foster

development is through communication of sexuality related

information.

Adolescents rank friends and parents (specifically mothers) as

the primary sources of sexual information, followed by (in consecutive

order): school, television, siblings, doctors, fathers, and books (Heisler,

2005). A survey from the Henry J. Kaiser Family Foundation (1999)

concluded that, “between the ages of 10-12, most children name their parents as their

primary source of guidance, advice and information about issues like sex, violence and

drugs and alcohol” (p. 2).

Communication

To more fully understand the impact of communication (both potential and actual)

it is important to understand the definition and process of communication in general.

“Communication is characterized by information transfer, processing takes place in

communication systems, both the sender and receiver are actively involved in a

communication system, and the quality of communication varies” (Losee, 1999, p. 7).
Parent-Adolescent Communication
about Sex 39
The level at which we communicate with people depends on the depth and

intimacy of the relationship as well as how engaged an individual is in the

communication process. While all forms of communication have their appropriate place,

there are some that will certainly help deepen relationships and allow for proper and

adequate exploration of sexuality. Verbal communication can divided into five different

levels, also known as Powell’s levels of communication: (1) cliché or phatic

communication, (2) factual or reporting communication, (3) evaluative or judgment

communication, (4) gut level communication, and (5) peak communication (Hunt, 2002;

Peck, n.d.). Cliché conversations involve typical small talk or passing comments whereby

there is little two-way conversation or expression of thoughts, ideas, or emotions (Hunt,

2002; Peck, n.d). Parents who talk to their kids about sexuality at this level may simply

state their disapproval of sexual activity or discuss the topics at a minimum. At this level

of communication the communicator often does not truly care about a person’s thoughts

or feelings or there may be no actual meaning to the conversation (Hunt, 2002; Peck,

n.d.). Factual or reporting communication typically does not involve expressing thoughts

or feelings about the information, but is rather a simple testimony of information, hence

this level of communication does not allow for open analysis of deeper sexual matter,

which is essential in the exploration of sexuality related issues (Hunt, 2002; Peck, n.d.).

This level of communication frequently occurs in parent-adolescent sexuality-based

discussions whereby parents will simply give facts about physiology (i.e. menstrual

cycles), pregnancy rates, or information about contraceptives and there is little two-way

critical discussion. While factual communication may be one of the most common forms

of sexuality-based communication, it is certainly not the most productive or beneficial to


Parent-Adolescent Communication
about Sex 40
adolescent sexual health. Evaluative or judgment communication (third level) involves

the expression of opinions and often includes conflict of ideas (Hunt, 2002; Peck, n.d.).

The fourth level (gut level communication) typically includes conversations between

individuals who are well known to each other and involves the sharing of emotions and

feelings (Hunt, 2002; Peck, n.d.). Adolescents need adults to thoroughly acknowledge

their stage of development, which the success thereof typically involves the expression of

thoughts and emotions (Kreinen, 2001). Finally, peak communication (highest level of

communication) involves people in the most intimate of relationships (i.e. marriage or

parent-child) and involves sharing emotions, but at higher levels of passion (Hunt, 2002;

Peck, n.d.). Peak communication requires a certain level of trust between individuals as

well as a well built rapport. Peak communication, including open and supportive

communication styles, appear to be most constructive in promoting proper sexual health.

General communication and parent-adolescent (specifically mother-adolescent)

sexuality-based communication (sex education) appear to be related, with a positive

correlation between the two (when reported by adolescents) (Baldwin & Baranoski,

1990). Further considering the role of sexuality-based communication in the sexual

development of adolescents, “individuals and society benefit when children are able to

discuss sexuality with their parents and/or other trusted adults…young people who are

involved in sexual relationships need access to information about health care services”

(National Guidelines Task Force, 1991, p. 5). Further, the Henry J. Kaiser Family

Foundation (1999) declared that, “parents say that open communication best prepares

children to make wise decisions. And, kids who have had conversations with their parents

say they were glad to have talked and got good ideas about how to handle the issues”
Parent-Adolescent Communication
about Sex 41
(p. 2). Adolescents reported a stronger satisfaction with overall family relations when sex

education occurred more frequently (Baldwin & Baranoski, 1990). The American

Academy of Pediatrics (AAP) further expressed the role of parents and communication:

Parents have the opportunity to foster their children's lifelong physical, emotional,

and sexual wellbeing by providing their children with accurate, honest, and age-

appropriate sexual health information. Educators and health-care professionals

can help facilitate this process by teaching parents the benefits of discussing

sexual health with their children as well as techniques to facilitate open and

honest communication about sexual health (Hellerstedt & Radel, n.d., p. 31).

The theoretical impact of communication about sexual behavior can best be

explained by Fishbein’s Theory of Reasoned Action (TRA). The premise of the TRA

includes the notion that a person’s intention to engage in a certain behavior, engagement

in sexual behavior in this case, is contingent upon approval/disapproval of the behavior

by relevant others (Subjective Norm) combined with their attitude towards the behavior

in question (Glanz, Rimer, & Lewis, 2002). Focusing on subjective norms, this construct

includes what relevant others (parents, friend, significant others) think the person should

do, combined with their motivation to comply with the beliefs and wishes of the relevant

others (Glanz, Rimer, & Lewis, 2002). Adolescents who perceive their parents to

disapprove of sexual behavior combined with their motivation to please their parents or

avoid parental reprimand, show less intention to engage in such behaviors. In another

example regarding the use of contraceptives, two factors (Normative Beliefs and

Motivation to Comply) have been successful in predicting contraceptive usage, where

mothers more accepting of contraceptive use combined with the adolescent wanting to
Parent-Adolescent Communication
about Sex 42
appease their parents, had daughters who used contraceptives on a more frequent basis

(Jorgensen & Sonstegard, 1984).

While the TRA explains the role of communication in predicting behaviors,

sexuality communication between parents and adolescents serves a greater role than to

curb risky sexual activities. As the SHM designates, there are many aspects of human

sexuality that go beyond the act of sex itself. Parents may wish to include these aspects of

sexuality in their discussions; including proper expression of love and affection beyond

physicality or how sexuality is incorporated into ones culture (i.e. what it means to be a

“man” or “woman”). Early adolescents indicated they want parents to discuss matters

related to sexuality beyond sexual intercourse such as love and trust (Richardson, 2004).

Many parents also wish their adolescents adopt certain morals or principles related to

sexuality that are similar to their own. It has been recommended that parents share

culturally appropriate morals, as this has the potential to delay sexual activity (Guilamo-

Ramos & Bouris, 2008). A plethora of motives drive parents to incorporate their own

values and thoughts regarding sexuality on their children, whether it is wanting the child

to value sexuality or understand the role of religion in sexuality. Whatever the reason,

parent-adolescent communication has shown to be successful in successfully transmitting

morals and principles to children. When parents communicate their beliefs to their

children, the adolescent is more likely to sanction that belief or thought process (Dittus,

Jaccard, & Gordon, 1999). While some ideas and values held by parents may prove to be

not conducive to sexual health, parents can successfully foster sexual health. In either

case, the role of the parent and communication is of utmost importance.


Parent-Adolescent Communication
about Sex 43
Although individual aspects of parent-adolescent, sexuality-based discussions that

are conducive to the development of positive sexual health beyond the behavioral realm

have not been studied extensively, several aspects related to productive communication

have been explored. Factors that mediate positive discussions have been identified by

Blake, Simkin, Ledsky, Perkins, and Calabrese (2001) in their review of literature; they

include, “the frequency and specificity of communications; the quality and nature of

exchanges; parental knowledge, beliefs and comfort with the subject matter; and the

content and timing of communications (for example, whether they take place before the

young person initiates sexual activity)” (p. 52). These are similar to factors previously

discussed including, “the extent of communication (measured in terms of frequency and

depth), the style or manner in which information is communicated, the content of the

information that is communicated, the timing of the communication, and the general

family environment (i.e. the overall quality of the relationship between parent and teen)

in which the communication takes place” (Jaccard, Dittus, & Gordon, 1998, p. 247).

Content of Parent-Adolescent Sexuality-Based Discussions

Sexuality related information is essential in the formation of attitudes and for

making decisions related to sexual behavior and adolescents need parents and/or adult

mentors to give them information related to sexuality (Kreinen, 2001). The possible

implications of parents discussing some sexually related topics over others are many.

Behaviors, such as masturbation, are normal in the natural sexual exploration of

adolescents (University of Michigan Health Systems, 2008). Further, behaviors, items,

and lifestyles, such abortion and prostitution, pornography, and alternative sexualities are

part of our current mainstream society. Yet these are some of the topics about which
Parent-Adolescent Communication
about Sex 44
parents either refuse or are unable to speak to their children (Heisler, 2005; Jordan, Price

& Fitzgerald, 2000). Failure to discuss these topics potentially leaves adolescents with

unanswered questions, wondering if they are normal (in terms of masturbation for

instance), forcing adolescents to seek information elsewhere (possibly from unreliable

sources), misunderstanding the dangers of some non-coital sexual behaviors, and not

understanding how their own viewpoints on these topics either conforms or conflicts with

those in their culture. In addition, as important as fact based information is, it is also

important that parents provide adolescents with practical skills and teach their children

the importance of proper decision making; which it appears parents are not doing in terms

of sexuality. Casper (1990) reiterated the importance of going beyond discussing

physiological aspects of sexuality (e.g. conception) as discussing aspects of conception

(for example) does not decrease the likelihood adolescents will abstain from sexual

intercourse.

A review of several studies related to content of parent-adolescent sexuality based

communication revealed that many parents stick to mainstream sexuality issues including

(but not limited to) dating, the physiology of the human body, and the negative impacts

of sexual behavior (i.e. STI’s or unwanted pregnancy). Many parents do their best to

avoid sexuality-based discussions due to awkwardness. Those parents who attempted to

evade conversations regarding sexuality with children made an effort to discuss topics

that were biological in nature and fact-based and not to engage in any joint

communication (Rosenthal, Feldman, & Edwards, 1998). Fox and Inazu (1980a)

concurred that topics discussed between parents and adolescents are typically fact based

and often include physical development. Six areas of sexuality (menstruation, dating,
Parent-Adolescent Communication
about Sex 45
sexual morality, conception, intercourse, and birth control) were discussed with

“menstruation and dating being the most discussed topics and intercourse/birth control

being the least discussed” (Fox & Inazu, 1980a, p. 348). Additionally, parents typically

avoided topics that were inviolable, including (but not limited to) masturbation, abortion,

prostitution and (although to a lesser extent) contraceptive use (Fox & Inazu, 1980a). The

majority of parents discussed reproduction and issues related to HIV/AIDS (Henry J.

Kaiser Family Foundation, 1999). Some parents also went well beyond the physiological

aspects of sexuality to discuss more practical issues, such as contraception, proper sexual

timing, and how to handle pressure to engage in sexual activity (Henry J. Kaiser Family

Foundation, 1999).

Similar results also were found by Eisenberg, Sieving, Bearinger, Swain, and

Resnick, (2006), who conducted a telephone interview of 1069 parents of adolescence to

assess parent-adolescent communication regarding sexual issues. The authors concluded:

Parents were most likely to talk a great deal about the

consequences of pregnancy (49.6%) and the dangers of sexually

transmitted diseases (41.4%). Approximately one quarter to one-

third of parents who completed survey interviews reported

talking with their teens a great deal about the potential negative

impact of having sex on their social life and the idea of waiting

until marriage to have sexual intercourse (pp. 897-898).

Other common topics included the responsibilities of parenthood, STI’s, dating,

serious relationships, and waiting until one is married before engaging in sexual

intercourse, the possibility of ruining ones reputation, regret, and how engaging in sexual
Parent-Adolescent Communication
about Sex 46
activity went against the wishes of the parents (Jordan, Price, & Fitzgerald, 2000).

HIV/AIDS, STI’s, contraceptives, and issues related to dating/having a significant other

were also frequently discussed issues (Miller, Kotchick, Dorsey, Forehand & Ham,

1998a). Other frequently reported topics discussed between parents and adolescents

included; resisting pressure to engage in sexual intercourse/postponing sex (Hutchinson

& Cooney, 1998; Jones, Singh, & Purcell, 2005; Dutra, Miller, & Forehand, 1999);

relationship issues as a whole and the values of sexuality (Raffaelli & Green, 2003);

choosing a sex partner/when to start having sex (Dutra, Miller, & Forehand, 1999); and

the moral/religious issues related to contraception (Heisler, 2005).

In terms of topics least discussed by parents, out of all the taboo topics (including

relationship issues, drugs and alcohol, money issues, etc) parents felt more comfortable

discussing any of these issues compared to discussing sex/sexuality in general (Golish &

Caughlin, 2002). Results of various research concluded that, out of all parents who have

discussed sexuality with their children; masturbation and non-coital sexual behaviors

(Jordan, Price, & Fitzgerald, 2000; Rosenthal & Feldman, 1999; Rosenthal, Feldman, &

Edwards, 1998; Miller et al., 1998a; Dutra, Miller, & Forehand, 1999) homosexuality

(Heisler, 2005); prostitution (Jordan, Price & Fitzgerald, 2000); pornography (Jordan,

Price & Fitzgerald, 2000); where to obtain birth control (Eisenberg et al., 2006);

and nocturnal emissions (Rosenthal, Feldman, & Edwards, 1998) were topics least

discussed. Rosenthal, Feldman, and Edwards (1998), summed up general

findings of these studies by concluding, that “topics discussed were biological

in nature and did not include any type of “practical advice” or on non-coital sexual

behaviors” (p. 734).


Parent-Adolescent Communication
about Sex 47
Another study assessed differences in abstinence vs. safer sex discussions using

direct observation of 50 mother-child pairs (Lefkowitz, Boone, Kit-fong Au, and Sigman,

2003). During conversations about HIV/AIDS, conversations tended to center around

non-sexuality related topics, such as issues with blood transmission, drug use, and people

known to the subjects to have HIV/AIDS (Lefkowitz et al., 2003). However, when

parents did discuss sexuality components related to HIV/AIDS, more parents focused on

abstinence, delaying sexual intercourse, and contraceptives (Lefkowitz et al., 2003).

When dyads were asked to discuss HIV/AIDS, few parents actually took the initiative to

openly discuss abstinence or safer sex (Lefkowitz et al., 2003). In addition, conversations

centered on abstinence tended to involve dyads, whose children were more spiritual and

older in age (Lefkowitz et al., 2003). Implications of this study showed that parents may

be skeptical about bringing up sexual issues related to sexuality and HIV/AIDS. Further,

families who showed a more traditionalist/conservative attitude may avoid discussing

essential aspects of safer sex and HIV/AIDS avoidance beyond that of abstinence.

Many adolescents desired further sexuality related discussions with their parents

(Hutchinson & Cooney, 1998) and offered insight into which topics they deem important.

The Henry J. Kaiser Family Foundation (1999) declared that, “whether or not their

parents had talked with them about these tough issues, children as young as 10 still want

more information on how to deal with issues like how to know when you are ready to

have sex and how to protect against HIV/AIDS” (p. 2). Of the topics that adolescents

wished their parents would discuss, these included, “contraception, sexually transmitted

diseases as well as ways to deal with sexual pressures and how to sexually restrain”

(Fitzharris & Werner-Wilson, 2004, p. 281). Further, adolescents noted that they wished
Parent-Adolescent Communication
about Sex 48
these conversations would take place much earlier in their lives (Fitzharris & Werner-

Wilson, 2004). Rosenthal and Feldman (1999) shared that “sexual safety” and “societal

concerns” were important to discuss with adolescents (p. 843). The topics that were

considered least important for parents to discuss were, “those concerning experiencing

sex and solitary sexual activities. On the other hand, many young people, particularly

girls, considered it important for parents to communicate about sexual safety” (Rosenthal

& Feldman, 1999, p. 843). Adolescents gave further insight about topics they deemed

unimportant to discuss.

It was clear that both boys and girls considered it unimportant for parents to deal

with many of the sexual topics. For example, none of the 20 topics was rated by a

majority of boys as important for fathers to discuss and only two were rated as

important for mothers to discuss. Comparable figures for girls were one and nine,

respectively. The topics which were considered least important were, for the most

part, those concerning experiencing sex and solitary sexual activities. On the other

hand, many young people, particularly girls, considered it important for parents to

communicate about sexual safety (Rosenthal & Feldman, 1999, p. 843).

Frequency and Source of Sexuality-Based Communication

As countless parents have said to their children, “If I have told you once, I have

told you a thousand times.” Parents have deemed it important to reiterate their messages

on more than one occasion with the hopes that the continued bombardment of

information will help get their point across to the adolescent. The concept of going

beyond a one-time intervention or, in this case, a one-time conversation about sexuality,

has been shown to be important in the field of health education as single interventions
Parent-Adolescent Communication
about Sex 49
often are ineffective. However, the question remains as to whether consistent sexuality

based discussions between parents and their children is effective in developing attitudes

or changing behaviors. An analysis of studies revealed that frequency of parent-

adolescent communication may impact adolescent sexual health and sexual behavior,

with (for example) adolescent’s rating of the importance of sexuality based

communication being related to the frequency of communication (Rosenthal & Feldman,

1999). In addition, the TRA states that a person’s behavioral intention is modified by

what others think we should do (i.e. parental approval/disapproval of sexual activity).

Perceived maternal disapproval of sexual activity was conditional (in part) by the degree

of communication between parents and adolescents (Jaccard, Dittus, & Gordon, 2000).

Furthermore, when communication occurred more regularly, adolescent females

displayed more liable behavior (Fox & Inazu, 1980b).

Frequency of parent-adolescent communication also may be related to adolescent

perceptions of parental expertise and trustworthiness, which are both important factors in

developing higher levels of communication. When parental expertise and trustworthiness

were high, frequency of communication tended to rise (Guiliamo-Ramos, Jaccard, Dittus,

& Bouris, 2006a). It is important to note however that frequency of discussions in and of

itself may not prove to be conducive to sexual health. For example, when Neer and

Warren (1988) placed the frequency of parent-adolescent communication into a

regression model, “it did not predict adolescent attitudes related to discussions or

sexuality” (p. 158).

There are certainly other aspects related to the both the frequency of

communication and communication in general that may alter the course and outcome of
Parent-Adolescent Communication
about Sex 50
communication. These include the willingness to discuss sexuality issues, the

receptiveness of the adolescent, or the didactics of the communication process. However,

just because parents frequently discussed sexuality related topics, parents were not

necessarily supportive of said communication, placing a negative spin on the

communication process and affecting the outcome (Neer & Warren, 1988).

It is apparent that frequency of communication and the variables associated with it

play an important role in adolescent sexual health and communication in general.

Unfortunately, rates of overall parent-adolescent communication appear to be extremely

low (Henry J. Kaiser Family Foundation, 2002). Further, communication regarding

specific sexuality-related topics compared to general sexuality-related communication

revealed that adolescents typically reported less frequent communication about specific

sexual topics (Hutchinson & Cooney, 1998). These results demonstrate that while parent-

adolescent sexuality based communication happens infrequently, parents also may be

hesitant or uncomfortable discussing specific topics related to sexuality.

A more detailed analysis of studies related to the frequency of communication

revealed that, (1) mothers tend to talk to their children about sexual issues more so than

fathers, (2) parents and adolescent reports of communication are not compatible, and (3)

adolescents desire more communication with their parents than what is currently

happening.

The source (i.e. mothers, fathers, friends, etc) of sexuality related information and

communication may potentially play a role in adolescent sexuality. Somers and Surmann

(2004), in a study of adolescent preferred sources of sex education, confirmed that

adolescents preferred and valued parents as the primary source of sex education along
Parent-Adolescent Communication
about Sex 51
with friends and school based sexuality programs. However, many adolescents have a

certain parent or legal guardian with whom they more often seek sexual information and

engage in sexuality-related conversations. Preferring information from one parent over

another seems logical, as many adolescents feel closer to one parent over another.

Further, because the deepest of conversations involves a certain level of trust and

intimacy, it is natural for adolescents to have a preferred individual with whom they feel

comfortable discussing delicate issues and who they feel is an appropriate source.

Still, the source of information, whether mother, father, peer, or other relevant

other, appears to have an impact on sexual health. Somers and Vollmar (2006) assessed

the role of the family in adolescent sexuality, using a sample of 672 adolescents. Items

assessed included family closeness, communication about sexuality, comfort in

discussing sexuality, sexual attitudes, and sexual behavior (Somers & Vollmar, 2006).

Maternal variables were found to be important variables in frequency of sexual

intercourse, age of onset of sexual intercourse (for Hispanics), and sexual behavior while

paternal variables played little roll except with ninth graders (Somers & Vollmar, 2006).

In other words, mothers tended to play a larger role in the development of sexual health

and sexual behavior and may have a larger. Fathers, on the other hand, although having

an important and essential role in the lives of adolescents, may have little or an unknown

amount of impact when it comes to sexual health. Fathers were not rated significantly as

sexuality educators and fathers reported more frequent sexuality based communication

than did their children (Feldman & Rosenthal, 2000).

In terms of which parent is typically the primary sexuality educator,

communication with the mother seemed to be the norm, while communication with the
Parent-Adolescent Communication
about Sex 52
father occurred infrequently (Feldman & Rosenthal, 2000; Miller et al., 1998a; Raffaelli

& Green, 2003). A total of 73.8% of mothers in one study provided general sexuality

information to their adolescent, whereas paternal communication was extremely low

(20%) (Hutchinson & Cooney, 1998). The lack of paternal information may account for

paternal variables playing little or unknown role in the sexuality development of

adolescents. Similar results also showed more sexual communication between mothers

and daughters compared to mothers and sons (Rosenthal & Feldman, 1999). Both males

and females indicated that communication with their fathers was infrequent (Rosenthal &

Feldman, 1999).

While mothers and fathers as primary educator differ, parents also differ in what

topics they discuss with their children and how often said discussions took place. Further,

while mothers and daughters discussed an array of topics, fathers and daughters only

discussed about 1/3 of the topics assessed in their study (Nolin & Petersen, 1992).

Mothers only discussed about half of the assessed topics with their sons (Nolin &

Petersen, 1992). Added discrepancies were found between mothers, fathers, and

adolescents in terms of the frequency of sexual communications and specific sexuality

related topics (Feldman & Rosenthal, 2000).

The source of sexuality related information (mother vs. father) also appears to

make a difference in regards to the satisfaction level with communication. Many

adolescents reported contentment with both communication experiences and the overall

relationship with their mothers while few adolescents were satisfied with communication

with their fathers (Jones, Singh, & Purcell, 2005; Feldman & Rosenthal, 2000). A more

comprehensive examination revealed that girls tended to rate their mothers as better
Parent-Adolescent Communication
about Sex 53
educators with more frequent and positive communications, while boys indicated no

difference between mothers and fathers (Feldman & Rosenthal, 2000).

Although mothers tend to be both the primary and preferred source of sexuality

information, discrepancies in the comfort level of the discussions (between adolescent

and mother) and whether discussions were sufficient in addressing the adolescents’

information needs were found (Fox & Inazu, 1980b). Additional factors (beyond whether

adolescents received sufficient information) related to the relationship between the

mother-child and conversation dynamics have not been extensively studied; many of

which may explain the preference and existence of mothers as primary educators (Fox &

Inazu, 1980b).

In any case, it appears that adolescents value and report more positive experiences

with mothers than fathers. However, as one might expect, some topics/issues related to

sexuality can be better explained by one parent over another. Communication between

fathers and sons was more frequent than father-daughter conversations, while mothers

were more likely to talk to their daughters (Miller et al., 1998a). This pattern seems

logical given that fathers may have a hard time (for example) discussing aspects of

menstruation as many do not understand this experience. Mothers may have a hard time

empathizing with a young son who has just had his first nocturnal emission or first

erection. Rosenthal and Feldman (1999) verified the notion that adolescents prefer

discussing some aspects of sexuality with one parent over another. Adolescent females

tended to rate communication with their fathers as more important when discussing issues

related to maturity and psychosocial issues, while males prefer discussing the act of sex

itself with fathers, more so than females (Rosenthal & Feldman, 1999).
Parent-Adolescent Communication
about Sex 54
Although parents thought that the same messages should be given to children

regardless of gender (Guiliamo-Ramos, Dittus, Jaccard, Goldberg, Casillas, & Bouris,

2006b), both parents and adolescents tailored their conversations to the perceived need of

the adolescent based on gender. Adolescent girls tended to focus on issues related to

dating (relationships) and values, whereas adolescent males focused their conversations

more on practicing safer sex (protection) (Raffaelli & Green, 2003). Mothers tended to

focus on negative outcomes of sexual intercourse (i.e. pregnancy) with daughters and

believed that boys should be taught more about morals (Guiliamo-Ramos, et al., 2006b).

Nolin and Petersen (1992) also found some distinct differences in parent-adolescent

communication related to the gender of the child. While daughters received “fact-based

talks,” males were more likely to discuss “sociosexual issues” with parents, which the

authors defined as being general in nature (Nolin & Petersen, 1992, p. 68). This

information indicates a gender double standard when it comes to how parents view how

sexuality should be discussed. It appears that virginity and not becoming pregnant is

more valued in females, while it is expected that males will engage in sexual activity and,

therefore, need to be practice safe sex.

While many adolescents agreed that their parents (both mothers and fathers) were

their primary source of education and report being satisfied with the discussions, it is

important to note that many do not rate them highly as sexual educators when compared

to other sources of sexuality-related information. Many females preferred alternative

sources of information for sexuality issues, such as friends, publications, and the Internet,

which is becoming an increasingly popular source of sexual stimuli and legitimate

sexuality information (Williams & Bonner, 2006). Warren and Neer (1986) also assessed
Parent-Adolescent Communication
about Sex 55
sources of sexuality related information for adolescents. The following were indicated as

sources of information, “friends (79%), romantic partners (59%), sex education

classes/popular media (42%), and other relatives (14%)” (Warren & Neer, 1986, p. 97).

Discrepancies in Reported Communication

Reports of parent-adolescent communication showed that parents and adolescents

did not always agree that sexuality based communication actually took place (Jaccard,

Dittus, and Gordon, 1998). Parents were more likely to report that sexuality-based

communication took place and there is a lack of concurrence between parents and

adolescents in terms of reported sexuality related topics discussed during these

conversations (Jaccard, Dittus, & Gordon, 1998). Jaccard, Dittus, and Gordon (2000) also

reported that mothers and adolescents do not agree whether they have discussed sexual

matters, with mothers reporting more conversations than children (73% of mothers versus

46.1% of adolescents). Results of a study conducted by ‘Teen Today’ (reported by

SIECUS, 2001), indicated a discrepancy between parents and children in regards to

whether or not various sexuality based conversations took place (98% of parents vs. 76%

of children). In addition, from a study of almost 700 adolescents, while half of students

indicated not having sexuality related discussions about sex with their parents, 60% of

parents of these adolescents indicated that discussions had taken place (King & Lorusso

(1997). More specifically parents and adolescents were in disagreement when it comes to

discussions related to, “sexually transmitted infections, sexual intercourse, reproduction,

birth control, homosexuality, and sexual abuse” (King & Lorusso, 1997, p. 52). In

another example of discrepancies between parents and adolescents in terms of sexuality-

based discussions, “there were also instances when parents and children walked away
Parent-Adolescent Communication
about Sex 56
from their conversations with different impressions about what had really happened: for

example, close to a quarter of parents reported having covered topics that their child did

not recall having discussed” (Henry J. Kaiser Family Foundation, 1999, p. 2).

Timing of Sexuality-Based Communication

The (AAP) reported that parents should discuss specific sexuality related topics

(i.e. intercourse, STD’s, birth control, etc) before adolescents reach puberty and should

begin as early as three to four years of age (Hellerstedt & Radel, n.d.). Obviously,

education with individuals this young involves elementary issues, such as the naming of

body parts, difference between males and females, and explanation of bodily functions to

name a few. However, in terms of more complex topics, the age at which parents begin

discussing sexuality related issues varies. The Henry J. Kaiser Family Foundation (1999)

discussed both the timing and content of sexually-based parent-adolescent

communication. “Although many parents report starting to talk with their children by age

12 or earlier about alcohol/drugs, violence, AIDS, and the basic facts of reproduction,

most still do not raise other aspects of sex and sexuality, such as relationships and

responsibilities, until the teen years. Yet, many pre-teens say these are some of the very

issues they have questions about” (The Henry J. Kaiser Family Foundation, 1999, p. 2).

Other studies have shown that most parents begin discussing complex sexual issues

between 10 to 14 years of age or believe they should be discussed around these ages

(Clawson & Reese-Weber, 2003; Jaccard, Dittus, & Gordon, 2000; Fox & Inazu, 1980a).

Another study indicated that half of adolescents received their “talks” before reaching 13

years of age with the remainder (40%) receiving their talks between 13 and 15 years of

age (King & Lorusso, 1997).


Parent-Adolescent Communication
about Sex 57
The timing of sexuality based discussions, whether related to strict physiological

issues or greater sexuality topics have implications for future outcomes. When looking at

the timing of discussions, only 45% of mothers discussed menstruation before menarche

had occurred and, in terms of birth control, 58% of the adolescents reported having talked

to their mothers about birth control before engaging in sexual intercourse (Fox & Inazu,

1980a). While many experts declared that it is never too late to discuss sexuality issues

with adolescents, women who discussed sex with their parents before engaging in

intercourse were much less likely to (for example) initiate sexual intercourse [earlier

coital debut] (Hutchinson, 2002). Hutchinson (2002) also declared that, “general

communication with the mother, communication with the mother about condoms, and

sexual communication prior to sexual debut were significant predictors of consistent

adolescent condom use” (p. 243). “Early sexual communication was associated with both

later age at sexual initiation and consistent condom use” (Hutchinson, 2002, p. 244).

Unfortunately, many parents may begin sexuality-based communication after the

adolescent has already engaged in sexual intercourse, which (although still encouraged

and productive) may not have the same effect (Davis & Friel, 2001).

In looking further at age of first sexual intercourse compared to the timing of

sexual communication with parents, 57.9% of adolescents reported off-time

communication with their fathers and 41.6% reported off-time communication with their

mothers (Clawson & Reese-Weber, 2003). Additionally, reports on frequency of parent-

adolescent, sexuality-based communication showed that as the frequency of said

communication rose, so did the likelihood of having an on-time discussion in terms of


Parent-Adolescent Communication
about Sex 58
coital debut, thus showing another positive outcome of frequent sexuality based

discussions (Clawson & Reese-Weber, 2003).

Additional results pointed out that the timing of sexuality-based discussions was a

significant predictor of multiple sexual behavioral outcomes, including age of coital

debut and number of lifetime sexual partners (Clawson & Reese-Weber, 2003).

Adolescents who reported on-time discussions with their parents reported fewer sexual

partners, were older at the age of coital debut, and used more methods of contraception

(Clawson & Reese-Weber, 2003). Mueller and Powers (1990) also concluded that

conversations held with children at the middle school level may be more open to

communication than those at the high-school or college.

Quality and Nature of Parent-Adolescent Communication

Rosenthal, Feldman, and Edwards (1998) found that parents who discuss

sexuality related issues with their children did so very differently.

The differences between parents in their approach to sex communications were

more marked than their similarities. The variations served as a basis for a

classification scheme in which five types of mother adolescent communication

were identified: (a) avoidant; (b) mother reactive to teen’s sexual activities

(hereafter ‘‘reactive’’); (c) mother opportunistic, (d) child-initiated; and (e)

mutually interactive. The major characteristics of the five groups are described

below in detail (p. 730).

Mothers who were dubbed avoidant communicators had infrequent,

uncomfortable discussions with their adolescents (Rosenthal, Feldman, & Edwards,

1998). In looking further at who typically initiates discussions, adolescent daughters


Parent-Adolescent Communication
about Sex 59
would initiate conversations about dating and menstruation, but both mothers and

daughters would initiate conversations about other mentioned topics (Fox & Inazu,

1980a). Further, mothers dubbed avoidant communicators assumed that schools were

doing most of the educating and were uncertain of how to approach the topic (Rosenthal,

Feldman, & Edwards, 1998). Reactive communicators had very few, unilateral, sexually-

based conversations with their children and only did so in lieu of a situation, such as

romantic involvement by the adolescent (Rosenthal, Feldman, & Edwards, 1998).

Mothers reported that adolescents were often uncaring during conversations (Rosenthal,

Feldman, & Edwards, 1998). The majority of parents were opportunistic communicators

(Rosenthal, Feldman, & Edwards, 1998). Mothers spoke to their children about sex in

lieu of various occasions (i.e. seeing something related to sex on TV), but did so

infrequently (Rosenthal, Feldman, & Edwards, 1998). To decrease tension/anxiety, these

parents often chose specific settings or places to conduct “sex talks” (i.e. traveling in the

car) (Rosenthal, Feldman, & Edwards, 1998). Referring to opportunistic communicators

the Henry J. Kaiser Family Foundation (1999) affirmed, “parents also are taking

advantage of "teachable moments" to discuss these issues with their children: the media,

news and entertainment, often provide a reason for talking. However, many may be

missing good opportunities to talk, especially about the hardest topic to talk about, sex,

such as sex education classes in school or a visit to the doctor's office” (p. 2). Although

parents in the opportunistic group discussed issues beyond those in the biological realm,

such as the psychological issues related to sex, children often were insensitive and

parents often were “unaware of their children’s thoughts or feelings” (Rosenthal,

Feldman, & Edwards, 1998, p. 735). Child-initiated communicators waited until their
Parent-Adolescent Communication
about Sex 60
children approached them to discuss sexual issues (Rosenthal, Feldman, & Edwards,

1998). It was reported that adolescents often brought up topics sporadically; therefore, a

wide variety of topics were discussed (Rosenthal, Feldman, & Edwards, 1998). While the

discussion of various topics may be a good thing, mothers who waited for their children

to bring up the topic of sexuality were rated as low-supportive in nature (in regards to

discussions), indicating that this method may not be the most conducive to sexual health

(Neer & Warren, 1988). Finally, mutually-interactive communicators held discussions

that were two-way, initiated by both parties, personal in nature, encouraged by parents,

and covered a wide range of topics (Rosenthal, Feldman, & Edwards, 1998). These

communication sessions occurred much more frequently than those in other groups, were

“non-judgmental, and bidirectional” (Rosenthal, Feldman, & Edwards, 1998, p. 738).

Yowell (1997) also discussed three different types of communication styles :

power assertive, conflicted, and collaborative. In the power assertive style, mothers used,

“power and authority as the principal means for the transmission of rules, regulations,

and values concerning sexuality” (Yowell, 1997, p. 180).The lack of discussion related to

obstacles in this case is to be expected given that such domination does not allow the

adolescent to express any thoughts or ideas. Power assertive mothers also claimed that

adolescents were “able to accurately reflect parental expectations concerning sexual

behavior” (Yowell, 1997, p. 180). Conflicted mothers described a conflict of interest, in

that they wanted conversations to occur and wanted them to be “open and honest”

(Yowell, 1997, p. 181). However, fear of distancing their daughters or condoning sexual

behavior kept many from discussing sexuality-related issues (Yowell, 1997). When

mothers in this category reflected on discussions with children, their reflections primarily
Parent-Adolescent Communication
about Sex 61
focused on problems associated with discussions and feelings of “sadness and uncertainty

concerning relationships with their daughters” (Yowell, 1997, p. 181). Collaborative

communicators indicated high levels of satisfaction in parent-adolescent discussions.

Mothers in this category indicated that conversations were open and went beyond the

laying of rules to sharing thoughts and feelings, and engaging in mutual discussion

(Yowell, 1997). Yowell (1997) also stated, “mothers in this group stated a desire to

increase their capacities for tolerance and patience in an attempt to improve their

communication with daughters about sexuality” (p. 182). Mothers in the collaborative

group also took the initiative to discuss ways in which such conversations could take

place, including the practice of listening skills and allowing the child to lead or guide the

discussion (Yowell, 1997). Neer and Warren (1988) discussed the effectiveness of

collaborative communication. “As findings further demonstrate, open discussion paves

the way for mothers to potentially influence their children's sexual behavior and nurtures

trust in their sexual judgment” (Neer & Warren, 1988, p. 158).

Beyond the communication style of mothers, Yowell (1997) also discussed to

what degree adolescents were engaged in sexuality-based conversations by placing them

in categories entitled: Passive, Avoidant, and Active. Further, Yowell (1997) described

which engagement style correlated with the mother’s communication style, as described

above. Associations were found between passive engagement and power assertive

communication; avoidant engagement and conflicted communication; and active

engagement and collaborative communication style (Yowell, 1997). These results

indicated that sexual health conducive communication may be achieved by a

collaborative communication style, where adolescents are actively partaking in the


Parent-Adolescent Communication
about Sex 62
learning process and sharing thoughts, ideas, information, and values that will assist them

in becoming sexually healthy adults.

Several other studies also have examined the importance and relevance of the

quality and nature of parent-adolescent communication. Related to the style of

communication and the outcomes, at the junior high level, there appears to be a

correlation between sexual activity and friendly/attentive communication styles (Mueller

& Powers, 1990). Positive correlations also were found between adolescent sexual

behavior and contentious, expressive, dramatic, and dominant communication styles

(Mueller & Powers, 1990). Further, contraceptive use was positively correlated with

more friendly and attentive communication styles at the junior high level, while the

opposite (i.e. more dramatic) conversations were correlated with lower contraceptive use

(over junior high, high school, and college students) (Mueller & Powers, 1990).

Moreover, results of a study showing that more frequent parent-adolescent

communication led to partners discussing sexual risk taking, only held true when parents

discussed sex with their children in a “skilled and open manner” (Whitaker, Miller, May,

& Levin, 1999, p. 120). When parents (specifically mothers) discussed sexuality related

issues in an open and receptive fashion and discussed more sexuality related content, the

open/receptive style was correlated with a decrease in sexual activity (Dutra, Miller, &

Forehand, 1999).

Neer and Warren (1988) reiterated the importance of having supportive

communication. Supportive mothers more readily accepted their child’s point of view

regarding sexual issues, shared their own experiences during youth (i.e. feeling shy
Parent-Adolescent Communication
about Sex 63
around the opposite sex), felt a greater influence over potential sexual behaviors, and

preferred open discussions of topics such as contraception (Neer & Warren, 1988).

Ward and Wyatt (1994) conducted a retrospective study to assess what women

remembered from their communication experiences. For Caucasian women, participants

recalled verbal messages as being negative while, non-verbal messages as “positive and

instructional” (p. 195). Results of this study also showed women (specifically Caucasian

women) who recalled negative communication and an absence of positive non-verbal

communication were more likely to engage in risky sexual behavior (Ward & Wyatt,

1994). The way in which parents conduct themselves during sexuality-based

conversations also has implications outside of sexual health. “Parents who talk about

tough issues generally get good grades from their children who say their parents were

prepared, in touch, accessible and not embarrassed” (Henry J. Kaiser Family Foundation,

1999, p. 2).

A qualitative study involving women in their 30’s assessed what their mothers

told them about sex/sexuality and further reiterates the importance of conducting

communication in a health conducive manner (Brock & Jennings, 1993). Almost half of

participants reported limited or no talks related to sexuality. Participants whose mothers

had talked to them about sex remembered their discussions in a negative manner, with

mothers pushing regulations, cautions, and consequences of sexual intercourse, and

limiting discussions to a minimum (Brock & Jennings, 1993). Many participants

remembered their mothers showing signs of discomfort and avoidance and giving strong

negative non-verbal cues during sex talks (Brock & Jennings, 1993). In contrast, these

women desired more open, productive, and two-way communication during sex talks
Parent-Adolescent Communication
about Sex 64
(Brock & Jennings, 1993). While some participants wished that specific topics were

discussed (e.g. birth control and examining sex as an act of love instead of just

procreation), most simply desired a more positive experience (Brock & Jennings, 1993).

The importance of the quality and nature of communication lies in the fact that

adolescents may be more apt to talk to parents if they evaluate them highly in terms of

satisfaction with their relationship and communication. Feldman and Rosenthal (2000)

looked at influences of both adolescent’s evaluations of parents and parent’s evaluations

of themselves as sexuality educators. Influences on mothers’ evaluations (by teens and

mothers themselves) included the quality of communication between the parent and the

adolescent (Feldman & Rosenthal, 2000). Thus, high quality communication had the

potential to increase adolescents’ evaluations of mothers and, therefore, increase

communication. Eisenberg et al., (2006) further stated that, “general

satisfaction with communication, as well as several sociodemographic

characteristics of parents and children (notably parent sex, age group

race and political orientation and child sex and age), were also

associated with communication on multiple topics” (p. 898).

Differences were found in the manner in which parents communicate. Female

adolescents indicated that they had received what is considered to be more sexual-health

conducive (i.e. open and supportive) communication (Dutra, Miller, & Forehand, 1999).

On the other hand, males rated their parents equally in the manner in which they engaged

in communication and the topics discussed (Dutra, Miller, & Forehand, 1999). Further,

females reported that communication with their mothers was more direct while again
Parent-Adolescent Communication
about Sex 65
males reported similarities between parents in terms of direct vs. indirect communication

(Raffaelli & Green, 2003).

Haglund (2006) shared that many parents were supportive of two-way, open

communication, involving active listening and exploration of sexuality in a free

environment. With open, two-way conversation being the most sexual-health conducive

way to discuss sexuality, studies showed that this level of communication was not always

used. Adolescents often are hesitant to discuss sexuality with their parents (Fitzharris &

Werner-Wilson, 2004), parents often have difficulty staying on topic during sexuality-

related discussions (Boone & Lefkowitz, 2007), and communication regularly happens in

a dominant, lecture style format (Kahlbaugh, et al., 1997; Fitzharris and Werner-Wilson,

2004).

In regards to the nature and process of parent-adolescent communication,

Guiliamo-Ramos, et al., (2006b) attempted to gain a better understanding of the content

and process of sexuality based parent-adolescent communication using 63 mother-

adolescent pairs. During a series of focus group interviews, the authors discovered five

themes including:

The importance of discussing the need to wait to have sexual intercourse; the

importance of discussing the consequences of having sexual intercourse; the

difficulties of discussing specific, technical information about sexual intercourse

and contraception; how communication about sex is shaped by the adolescent’s

gender; and how communication about sex is affected by the contrast between

cultural backgrounds of mothers and the urban American neighborhoods in which


Parent-Adolescent Communication
about Sex 66
they now live (related to diverse racial/ethnic groups) (Guiliamo-Ramos et al.,

2006b, p. 174).

When discussing the importance of waiting to have sexual intercourse, mothers

commonly used the child’s education as a basis for delaying sexual intercourse, citing

that education was of critical importance and would be jeopardized if the adolescent

engaged in sex (Guiliamo-Ramos et al., 2006b). Many mothers also emphasized the

importance of waiting until marriage to engage in sexual intercourse, as it was “beautiful”

for a woman to be a virgin until marriage (Guiliamo-Ramos et al., 2006b, p. 174). It also

has been shown that parents often talk about possible future implications of intercourse

(Fitzharris & Werner-Wilson, 2004). Parents noted that when talking about

contraceptives, they talked about them in terms of the adolescent’s future (i.e. pregnancy

risks and male counterparts wanting a non-promiscuous partner) (Fitzharris & Werner-

Wilson, 2004).

Beliefs and Comfort with Sexuality Based Subject Matter

Regardless of whether or not parents were willing to personally discuss sexuality

related issues with their children, many parents are supportive of their children’s learning

at least some aspects of human sexuality. Rosenthal, Feldman, and Edwards (1998),

conducted a qualitative analysis, with 30 mothers of adolescents.

All mothers believed that parents had an important albeit non-exclusive role to

play in providing sex-related information to their children. They perceived that

adolescents were in need of sex education and, regardless of the amount or style

of their sexual communications, almost all mothers felt they were doing a good

job in providing their children with sex education (p. 730).


Parent-Adolescent Communication
about Sex 67
However, when parents take the initiative to discuss sexuality issues with their

children, their personal beliefs regarding sexuality as a whole, their knowledge level of

various sexual topics, and their (and their children’s) comfort level had the potential to

influence the course of the discussions and the outcomes thereof.

Jordan, Price, and Fitzgerald (2000) explained parents’ general beliefs related to

sexuality education. The mainstream portion of parents believed that sexuality education

should take place within the home and saw themselves as the primary source of sexuality

education (Jordan, Price, & Fitzgerald, 2000; Haglund, 2006). In addition, parents found

various outside resources helpful and encouraging when talking to their children about

sexual issues (i.e. books, brochures, newsletters ) (Jordan, Price, & Fitzgerald, 2000;

Jordan, Price, & Fitzgerald, 2000).

A portion of parents also supported school-based sexuality education and agreed

that sexuality education in the schools should take place before the 7th grade (64%)

(Jordan, Price, & Fitzgerald, 2000). In terms of sexuality education within the school

system, many parents felt that both abstinence and safer sex practices should be covered

in the curricula (85% and 76% respectively) (Jordan, Price, & Fitzgerald, 2000). It is

interesting to note that, in terms of other sources of sexuality education, religious

institutions were rated as the least supported source of sexuality education (Jordan, Price,

& Fitzgerald, 2000).

Related to the general beliefs parents held about sexuality education, parents’

beliefs/understanding about various sexuality issues have the potential to influence

adolescent sexuality. Eisenberg, Bearinger, Sieving, Swain, and Resnick (2004),

conducted a telephone interview of over 1,000 parents of adolescents ages 13-17 to


Parent-Adolescent Communication
about Sex 68
determine whether parents’ views on contraceptives were medically accurate. While most

parents believed that condoms were, in some way, effective against preventing STI’s,

only a fraction of participants believed that most adolescents were capable of using a

condom correctly (Eisenberg et al., 2004). Approximately half believed consistent birth

control use was effective “almost all of the time” and 43% believed it was effective

“most of the time” (Eisenberg et al., 2004, p. 53). However, 58% of parents believed that

a few of the adolescents could correctly use birth control (Eisenberg et al., 2004). Parents

with the least correct views/information of contraceptives (effectiveness) and

adolescent’s ability to use contraceptives were more conservative/traditionalist in nature

(Eisenberg et al., 2004). Further, it was found that women had the least accurate

views/information of condoms and adolescent’s ability to use contraceptives Women

however had more accurate views about oral contraceptives (Eisenberg et al., 2004). One

parental responsibility is to provide accurate and timely information related to sexuality

issues. Parents who are ill informed when it comes to issues related to contraceptives and

sexuality as a whole may be hesitant to discuss these issues out of fear of sounding

incompetent or being unable to answer the adolescent’s questions. Further, it is feared

that adolescents may receive inaccurate information and base their decisions on

wrong/incomplete data.

Study results assessing parental comfort in discussing sexuality related topics

reveal mixed results, with some studies disclosing that parents feel comfortable

discussing sexuality related topics and others reporting the opposite. The comfort level of

both parents and adolescents, had an impact on the dynamics of the conversation and will

affect the outcomes. Sexuality-based discussions appear to be extremely hard for parents
Parent-Adolescent Communication
about Sex 69
to conduct and that children often perceive their parents as ill-equipped to handle the

discussion (Henry J. Kaiser Family Foundation, 1999).

In assessing the comfort level of offspring as to which parent they felt more

comfortable in sexuality related discussions found that adolescent males are much more

comfortable discussing sex with their fathers as compared to females (Heisler, 2005).

Guiliamo-Ramos et al., (2006b) found that many children experienced some amount

discomfort, hesitance, embarrassment, and fear during sexuality based discussions;

however, many adolescents understood the importance of the discussions and the

importance of overcoming their own discomfort. Many women were uncomfortable

during sexuality-based discussions and this discomfort is apparent to adolescents who

report that parents appeared to be distressed during the conversations (32%) (Hutchinson

& Cooney, 1998).

Concerning comfort levels in discussing specific sexuality related topics, mothers

reported feeling comfortable discussing most topics, while adolescents reported

discomfort in talking about topics related to sexual behavior, morals, and principles (Fox

& Inazu, 1980a). On the other hand, Jordan, Price, and Fitzgerald (2000), examined

comfort level of parents in discussing sexuality related issues and indicated that the

majority of parents (65%) felt comfortable talking about sex (in general) with their

children.

As adolescents grow they develop a greater ability to utilize critical thinking and

can more deeply understand more intense sexuality issues and topics. Their informational

needs change as well. Nolin and Petersen (1992) examined the comfort level of parents in

discussing specific topics. “As the child developed and his or her need for information
Parent-Adolescent Communication
about Sex 70
regarding the interpersonal, erotic, or moral aspects of sexuality increased, parents felt

more challenged and less able to communication comfortably and effectively” (p. 70).

The Relationship Between Sexual Behavioral Outcomes and Parent-Adolescent Sexuality

Based Communication

The majority of existing studies related to parent-adolescent, sexuality-based

communication, have focused on the extent of communication (whether or not it has

taken place), comfort level of the parents, ability of parents to provide adequate and

accurate information, topics discussed during said conversations, and sexuality based

behavioral outcomes of the adolescent. Such behavioral outcomes include contraceptive

use, the age of first sexual activity, and the number of sexual partners. These studies have

yielded inconclusive results, with some indicating a positive influence of parental

communication on sexual behavior and others concluding that parental communication

encourages or is ineffective in altering sexual behavior. For example, Kirby (1999) and

Lieberman (2006) concurred with the uncertainty of the behavioral outcomes of parent-

adolescent sexuality communication. Kirby (1999) reviewed extensive resources related

to teen sexual behavior to look for implications for the future. In regards to parent-teen

communication:

Reviews of numerous studies of the impact of parent-child communication about

sexuality upon adolescent sexual behavior conclude that there is no simple

relationship between such communication and adolescent sexual behavior. Some

studies suggest that there is no relationship; some studies suggest that greater

communication is associated with more sexual risk-taking behavior (possibly

because the parents anticipate sexual behavior), and other studies indicate that
Parent-Adolescent Communication
about Sex 71
greater communication is associated with less sexual risk-taking behavior. It may

be the case that greater communication has positive effects under some

conditions, but not others, but even this is now being questioned (p. 92).

An abundance of studies related to parent-adolescent communication reported

positive correlations between sexuality-based communication and health-conducive

behaviors. For instance, one study found that parental communication was associated

with adolescents engaging in less frequent sexual activity and, for those who did engage

in sexual activity, a higher frequency of reported contraceptive use (Hutchinson,

Jemmott, Jemmott, Braverman, & Fong, 2003).

Other positive outcomes of parent-adolescent communication revealed that

general/frequent communication about sex (Hutchinson, Jemmott, Jemmott, Braverman,

and Fong, 2003; Hutchinson, 2002; Hutchinson and Cooney,1998; Warren and Neer,

1986; Pick and Palos, 1995; Blake et al., 2001; Whitaker & Miller, 2000); the discussion

of condoms (Hutchinson, Jemmott, Jemmott, Braverman, and Fong, 2003; Hutchinson,

2002); and having adolescents who deeply considered the consequences of sexual

intercourse (as related to communication) (Dittus, Jaccard, and Gordon, 1999) lead to

various positive outcomes. These positive outcomes included a decrease in the frequency

of engaging in sexual intercourse (Hutchinson, Jemmott, Jemmott, Braverman, and Fong,

2003); consistent use of contraception (Hutchinson, 2002; Blake et al., 2001); higher self-

efficacy in condom use; (Hutchinson & Cooney, 1998); sexual risk communication with

romantic partners (Hutchinson & Cooney, 1998); decrease in pregnancy (Pick and Palos,

1995); later age at coital debut (Blake et al., 2001; Whitaker & Miller, 2000); a decrease

in number of sexual partners (Whitaker & Miller, 2000); adolescents being more likely to
Parent-Adolescent Communication
about Sex 72
name their parent as the preferred source of sexuality related information (Whitaker &

Miller, 2000); less risky sexual behavior (Whitaker & Miller, 2000); less conformity to

peer norms (Whitaker & Miller, 2000); and overall adolescents were less likely to engage

in sexual intercourse (Dittus, Jaccard, & Gordon, 1999).

Warren and Neer (1986) also found that parents who failed to discuss sexuality

issues with their adolescents had children who were more likely to seek outside, possibly

less reliable, sources, such as friends and peers. Further, adolescents who perceived that

mothers approved of them engaging in sexual intercourse had a higher probability of

engaging in sexual intercourse (Jaccard & Dittus, 2000). In addition, adolescents who

perceived that their mothers approved of them using contraceptives were more likely to

not only engage in sexual intercourse more often, but also were more likely to use

contraceptives (Jaccard & Dittus, 2000).

Although the correlation between parent-adolescent communication and positive

sexual outcomes appears promising, various studies indicated that parent-adolescent

communication (and factors related to communication) may not lead to sexually healthy

outcomes. Miller, Norton, Fan, and Christopherson (1998b) concluded that the quality of

communication between parents and adolescents had no effect on sexual behavior for

adolescents. In another example, while virgin adolescents were more likely to name

parents as their preferred source of communication, “there was no difference between

virgins and non-virgins in terms of the quality of communication” (Handelsman, Cabral,

& Weisfeld, 1987, p. 461). Results also showed no difference between source of

sexuality information (parent, peer, or educational program) and the amount of sexuality

related knowledge held by the child (Handelsman, Cabral, & Weisfeld, 1987). Further,
Parent-Adolescent Communication
about Sex 73
part of the Handelsman, Cabral, and Weisfeld’s (1987) study assessed differences

between source of sexuality information and sexual outcomes. The source of sexuality

related information (friends or peers) had no impact on engaging in sexual intercourse or

using some form of contraception (Handelsman, Cabral, and Weisfeld, 1987). In addition,

adolescents who reported poor communication with parents, “were no more likely to

express a preference for a peer educator than were subjects with more positive and open

communication” (Handelsman, Cabral, & Weisfeld, 1987), p. 460). From a study of 542

college students, those who came from homes of frequent communication were no less

likely to delay coital debut, engage in sexual intercourse, use contraceptives than students

who came from homes where communication was minimal (Fisher, 1988). However,

sexual communication may be successful in developing adolescent sexual attitudes that

are in tune with those of their parents (specifically through late adolescents) (Fisher,

1988). Fisher (1986) also found that the correlation between communication and positive

sexual outcomes was blurred. In this study, parents and adolescents were placed within

low and high communication categories to determine if attitudes would be similar based

on communication. With the exception of late adolescents, children tended to have

attitudes that were more liberal compared to those of their parents, despite of the

frequency of communication (Fisher, 1986). Young adolescents held similar attitudes to

those of their parents; however, they may have been too young to form their own

attitudes (Fisher, 1986). In another study by Fisher (1993), a series of correlations using

different instruments was conducted between parent-adolescent communication and

various sexual behavior variables, such as number of students engaging in sexual

intercourse, number of sexual partners, and contraceptive use. No correlation was found
Parent-Adolescent Communication
about Sex 74
between parent-adolescent communication and the noted behavioral variables (Fisher,

1993). Newcomer and Udry (1985) found a significant correlation between parent-

adolescent communication and two sexual outcomes of adolescents (initiating sexual

intercourse and using contraceptives). However, this finding only held true for female

adolescents. The associations also were dependent upon who reported the

communication. For example, the association between communication and initiating

sexual intercourse was not significant when daughter reported communication

(Newcomer and Udry, 1985). In addition, the association between communication and

contraceptive use was not significant when mothers reported communication (Newcomer

and Udry, 1985). Dutra, Miller, and Forehand (1999) also found a discrepancy in

behavioral outcomes of parental communication. Results of this study revealed that, “in

terms of the process and content of sexuality-based discussions, only maternal

conversations were found to be associated with adolescent risk taking” (p. 59).

Barriers to Communication

The identification of the various barriers to effective sexuality-based

communication is essential in fostering efficient and valuable communication. Jaccard,

Dittus, and Gordon (2000) shared that various barriers to communication were prognostic

of sexuality based communication. These reservations included fear of embarrassment

and intrusion of the parent by the adolescent along with fear of the mother lacking the

knowledge to answer a question (Jaccard, Dittus, and Gordon, 2000).

Barriers to communication noted by parents included discomfort, fear of sending

mixed messages, fear of actually believing in mixed messages, and not knowing when to

start (Fitzharris & Werner-Wilson, 2004). Two primary reasons parents (specifically
Parent-Adolescent Communication
about Sex 75
mothers) are hesitant to discuss sexuality related topics with their children are that they

are afraid of embarrassing their children and afraid that the adolescent will ask a question

of which the parent does not know the answer (Jaccard, Dittus, & Gordon, 2000).

In addition, adolescents have discussed barriers to communication which included

embarrassment/feeling uncomfortable, fear of reprimand or fear their parents would

believe they were sexually active, if the topic is brought up, or belief that their parents

were uneducated in regards to the subject (Fitzharris & Werner-Wilson, 2004).

Adolescents also cited “self-protection, relationship protection and conflict avoidance” as

the primary reasons for not discussing issues with parents (Golish & Caughlin, 2002, p.

78).

Erven (n.d.) also discussed some common barriers to effective (general)

communication, some of which are especially critical in sexuality based communication.

The first involves two-way communication, in which feedback is given. Feedback

ensures that the message has been sent and interpreted correctly and without it, two-way

communication cannot exist (Erven, n.d.) As previously discussed, open, two-way

communication seemed to be the most conducive to proper sexual health. Parents must

ensure that the adolescent understands what is being said and when information, wants,

and desires of adolescent are clearly communicated, those needs are being met. Another

complication involves the speaker and listener speaking a different “language” (Erven,

n.d.). In today’s society, there is no lack of slang or popular lingo used to describe

sexuality and sexual practices. In this case, parents need to be sure that what they are

saying translates into the appropriate language of the adolescent. Erven (n.d.) further

discussed the danger of stereotyping; which includes stereotyping a topic such as


Parent-Adolescent Communication
about Sex 76
sexuality. In this case, the attitudes or thoughts towards sexuality by the parent or the

attitude of the adolescent in listening to the parent discuss sexuality (thinking they

already know what is their parents are going to say) can greatly affect the outcome of the

communication experience. Another common barrier to communication, making

assumptions about the listener, indicates aggressive (non-productive) communication

(Union Education Trust, 2006). Many parents fear that if adolescents bring up the topic of

sex/sexuality, it means their child is actually engaging in sexual activity. Understanding

that sexuality is a natural part of growing up and that adolescents are curious about

sexuality, parents must learn not to assume that their children are sexually active. Finally,

parents must learn to give adequate time for sexuality based discussions. The National

School Boards Associations (2008) indicated that inadequate communication will take

place if the individuals involved are under time constraints.

In addition, many parents and teachers greatly underestimate the sexual activity of

their adolescents (Jaccard, Dittus, & Gordon, 1998). Similar results were found by

Jordan, Price, and Fitzgerald (2000), who found that a total of 79% believed that their

children were not sexually active, while many parents believed that their children’s

friends were sexually active. Bylund, Imes, and Baxter (2005) reported

similar findings:

The parents of the college students in this sample seemed to be

overoptimistic about their college students’ health and health

risk behaviors. Although parents had accurate perceptions of

many of their college students’ health risk behaviors, they

underestimated their college student children’s frequency of


Parent-Adolescent Communication
about Sex 77
drinking, binge drinking, engaging in sexual intercourse, using

marijuana, and smoking at least 1 cigarette. In addition, parents

tended to rate their college students’ health higher than the

college student rated it. Whereas parents did have many

accurate perceptions of their children’s behavior, in no cases did

the students report better health or healthier behaviors than

their parents’ perceptions revealed (p. 35).

Many parents tended to underestimate the sexual activity of their children under

certain circumstances, including having a more religious adolescent, having a parent who

strongly disapproves of sexual activity, having a male child versus a female, having an

older parent (mother), less parent-adolescent communication, and when parents perceive

a positive relationship between themselves and their children (Jaccard, Dittus, & Gordon,

1998). The opposite has been shown to be true, with parents talking

more to their children about sexual issues if they believe them to be

sexually active or in a romantic relationship. “Parents who believed

their children had been involved in a romantic relationship were more

likely to report talking “a great deal” or “a moderate amount” about

aspects of sexuality and sexual behavior, for five of the six topics

(exception was “waiting until marriage”) than were parents who

believed their teenagers had not been romantically involved”

(Eisenberg et al., 2006, p. 898).

Underestimating sexual activity is a barrier to communication in

parents may not feel the need to discuss sexuality-related issues,


Parent-Adolescent Communication
about Sex 78
therefore inhibiting communication. Parents who may delay discussing

sexuality related topics with their children because they believe they

are not sexually active (when the research shows otherwise) risk

leaving children to make uninformed decisions about their sexual

health.

Other Influences on Sexual Health, Sexual Behavior, and Communication

It is evident that the correlation between parent-adolescent communication and

sexual outcomes is unclear and that communication in and of itself is only one of many

factors that influence adolescent sexual health development. Studies on adolescent sexual

behavior confirmed that other aspects of family dynamics beyond communication have

an effect on sexual behavior, such as parental approval of sexual activity, family

connectedness/cohesiveness, overall satisfaction with the relationship, trust level, comfort

level during sexual communication, and whether the parents perceive their children to be

sexually active; all of which have some effect on communication (Kirby, 1999). There

are factors outside of communication that influence not only communication but also

behavioral outcomes.

Although many adults – and also adolescents – believe that greater parent-child

communication about sexuality is a good thing, in and of itself, simply increasing

parent/child communication about sexuality probably does not have the marked

behavioral impact that we once believed it had. Instead, other qualities of family

interaction (e.g., overall connectedness) may be far more important (Kirby, 1999,

p. 92).
Parent-Adolescent Communication
about Sex 79
Lederman and Mian (2003) gave greater insight into aspects of parenting and family

dynamics that play a role in adolescent sexuality in their review of literature. “Family

involvement, family structure, parental values, parental monitoring, and parent-child

communication are important factors influencing critical life choices and are a crucial

part of teen pregnancy prevention” (p. 34).

Adolescents who had a better relationship with their parents may be more apt to

openly discuss sexuality related issues, leading to positive sexual outcomes. Jaccard,

Dittus, and Gordon (1996) showed the positive impact of adolescent satisfaction with the

quality of the relationship between mother and child on adolescent sexual behavior.

Adolescents who were dissatisfied with their maternal connections were more liable to

engage in sexual behavior (Jaccard, Dittus, & Gordon, 1996). Another study found that

maternal-adolescent relationship satisfaction was associated with a lower probability of

engaging in sexual intercourse, having a pregnancy, and a higher probability of using

contraceptives during intercourse (Dittus & Jaccard, 2000). Similar results also were

discussed by Jaccard, Dodge, and Dittus (2003) who concluded that positive relationship

satisfaction was related to negative adolescent pregnancy attitude. Furthermore,

“adolescents from mother-teen dyads who have good, solid relationships with one

another are less likely to be engaging in premarital sex, are less likely to be having

frequent sex, and are more likely to be using contraceptive consistently in the event that

they are having sex” (Dittus, Jaccard, and Gordon, 1999, p. 1955).

Concerning matters of trust and disclosure, both parental trustworthiness and

parental expertise were related with risky sexual behaviors (Guiliamo-Ramos et al.,

2006a). Nevertheless, parents and adolescents have different issues when it comes to trust
Parent-Adolescent Communication
about Sex 80
and divulging information (Smetana, Metzger, Gettman, & Campione-Barr, 2006).

Parents felt that their adolescents were more duty-bound to disclose information as

opposed to adolescents, who perceived that they have to divulge less information than

expected by their parents (Smetana et al., 2006). In terms of the types of information

expected to be disclosed, the authors stated, “adolescents were seen as more

obligated to disclose prudential issues and less obligated to disclose

personal than moral, conventional, and multifaceted issues” (Smetana

et al., p. 201). Further, personal issues were more frequently disclosed to mothers as

opposed to fathers (Smetana et al., 2006).

Adolescents who are consistently forced to divulge personal information may be

prone to lie to their parents. Knox, Zusman, McGinty, & Gescheidler (2001) conducted a

study on adolescent deception, using 281 undergraduate students. Females were more

likely to lie about their sexual behavior and were more likely to lie to their father, while

males were more likely to lie to their mother (Knox et al., 2001). Over half of the

adolescents reported that their lying was effective in deceiving their parents (Knox et al.,

2001). As warned by Miller (1998), when parents asserted overt control or perhaps in this

instance, expected excessive personal disclosure, adolescents were less inclined to

divulge such information and may, in fact, lie about sexual behaviors; thus hurting the

relationship and discouraging future productive communication.

Casper (1990) also found two family variables related to adolescent sexual

behavior. Mother’s education and socioeconomic status depressingly affected the

probability of adolescents engaging in sexual intercourse (Casper, 1990). Lower

socioeconomic status and lower educational attainment by the mother correlated with an
Parent-Adolescent Communication
about Sex 81
increased likelihood of the adolescent engaging in sexual intercourse (Casper, 1990).

Fathers with lower educational attainment were correlated with a younger coital debut for

the son (Lehr, Demi, Dilorio, & Facteau, 2005).

In regards to the role of family involvement in adolescent sexual development,

Casper (1990) confirmed the idea that family involvement is conducive to proper sexual

health. Family interactions can help adolescents curb unwanted sexuality related

outcomes by the family working with them during the decision making process. Family

interaction can, moreover, positively influence an adolescent’s decision to use

contraceptives (Casper, 1990). Another study was conducted to assess the effectiveness

of parental involvement in school-based abstinence-only education (Blake et al., 2001).

The parental involvement aspect included parents assisting their children in homework

assigned after a school based intervention. When parental involvement was implemented

along with school based curricula regarding sexual issues, children were more likely to

report greater efficacy in refusing risky behaviors, more communication with parents and

students were more likely to want to remain abstinent during their high school years

(Blake et al., 2001). Additionally, L’Engle, Jackson, and Brown (2006), found that

students who were more susceptible to engaging in sexual intercourse reported “fewer

positive connections with parents” (p. 97).

Part of parental involvement includes parents continuously monitoring the

behavior of their children in terms of sexuality behaviors and otherwise. In their

publication abstract, Romer, Stanton, Galbraith, Feigalman, and Li (1999) shared:

Children who reported high levels of parental monitoring were less likely to

report initiating sex in preadolescence (aged <10 years) and reported lower rates
Parent-Adolescent Communication
about Sex 82
of sexual initiation as they aged. Children who reported receiving both greater

monitoring and communication concerning sexual risks were also less likely to

have engaged in anal sex. Communication was also positively related to the

initiation of condom use and consistent condom use. The protective correlates of

these parenting strategies were independent of the type of guardian (mother vs.

other family member) (Romer et al., 1999, p. 1055).

In a study assessing the impact of family connectedness on sexual risk taking

among 976 urban adolescents, adolescents who scored higher on the scale of family

connectedness were less likely to, “report ever having had sex, recently having had

unprotected sex, having been involved in a pregnancy, and having initiated sex prior to

age 13 [for those who were sexually active]” (Markham, Tortolero, Escobar-Chaves,

Parcel, Harris, & Addy, 2003, p. 174).

General parental disapproval of sexual intercourse also has been shown to play a

factor in adolescent sexual activity. For instance, children who perceived their parents

approval for engaging in sexual intercourse were more likely to report an earlier coital

debut (Davis & Friel, 2001). Jaccard and Dittus (2000) concluded that, “higher levels of

perceived approval were associated with increased pregnancy incidence for the

unweighted but not the weighted analysis” (p. 1428). Further, Jaccard and Dittus (2000)

hypothesized that parental approval of birth control would increase when parents

believed their child was sexually active or about to become sexually active. However, the

results of the study indicated that this hypothesis was not true (Jaccard & Dittus, 2000).

Jaccard, Dittus, and Gordon (1996) also discussed the impact of parental

disapproval on the sexual behaviors of adolescents. Maternal disapproval of intercourse


Parent-Adolescent Communication
about Sex 83
was associated with both abstinence and fewer sexual encounters (Jaccard, Dittus, &

Gordon, 1996). When adolescents perceived that mothers did not approve of them

engaging in sexual intercourse, they were less likely to engage in sexual intercourse or

become pregnant (Dittus and Jaccard, 2000). Jaccard, Dodge, and Dittus (2003) also

found that perceived maternal disapproval of adolescent sexual intercourse led to higher

negative adolescent pregnancy attitudes.

It has been theorized that the structure of the family (i.e. married vs. divorced

parents, single parent households, etc) may play a role in adolescent sexual development

and parent-adolescent communication. For example, adolescents may have difficulty

adapting to and trusting a step-parent and, therefore, may be less likely to disclose

personal information or discuss something as intimate as sexuality issues. Case-in-point,

girls from single-parent households were more likely to report an earlier sexual debut

than in households where both parents dwelled (Davis & Friel, 2001). Nevertheless,

“among youth in one-parent households, having the family communication asset was

significantly associated with increased odds of birth control use at last sexual intercourse”

(Oman, Vesely, & Aspy, 2005, p. 30). Analyses also were conducted with adolescents

from stepfamilies, cohabitating families, and lesbian families, which were found to have

no effect on earlier sexual debut (Davis & Friel, 2001).

In examining the impact of other family dynamics on the sexual

behavior/attitudes of adolescents, adolescents who had mothers who were not pregnant

until marriage and who had a more positive perception of their mother, reported never

being pregnant (Pick & Palos, 1995). Results of another study also indicated that mothers

who had had intercourse when they were their children’s age, were more likely to have
Parent-Adolescent Communication
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sexually active children (Newcomer & Udry, 1984). Mothers previous sexual experiences

may have helped shape their current views and attitudes toward sexuality. These thoughts

and attitudes could have been passed on to the adolescent who in-turn adopted the same

attitudes.

While parents and family play a primary role in the development of sexuality in

the life of an adolescent, “as kids reach the teen years, they are increasingly likely to

name other outlets, including friends and the media, as places where they get more of

their information” (Henry J. Kaiser Family Foundation, 1999, p. 2). Speaking of the role

of peers in the lives of adolescents, Kaufman (2006) discussed the importance of

friendship and peer acceptance during adolescence by stating, “Identifying with a

peer group is the key developmental task of adolescence. Teenagers

move best into a peer group when they know they can also count on

their connection with their family. Parents sometimes see this move to

a peer group as a rejection and pull away support at this crucial time”

(Kaufman, 2006, p. 289). When adolescent peer norms are supportive of sexual

activity, the adolescent will be more likely to engage in sexual behavior (O’Donnell,

Myint-U, O’Donnell, & Stueve, 2003). Further, having an older romantic partner

significantly increases the adolescent’s probability of engaging in sexual behavior

(Vanoss Mari´n, Coyle, Go´mes, & Kirby, 2000). Miller, Norton, Curtis, Hill,

Schvaneveldt, and Young (1997) found similar results in that, “having sexually active

friends and beginning to date, as well as dating frequently among males and the early

onset of dating among females, provides an opportunity context that dramatically

increases the risk of having sexual intercourse” (p. 77).


Parent-Adolescent Communication
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Several factors associated with an adolescent’s development stage that may

influence communication by parents have been assessed in previous research. More

specifically, fathers were more likely to discuss sexual issues when they notice that their

sons (in particular) reach a certain level of physical maturity (Lehr et al., 2005). This

timing may be due to the fact that fathers at a certain point begin to realize that their sons

are more likely to become sexually active (Lehr et al., 2005). Lehr et al., (2005) also

discussed other aspects related to paternal communication. “Father's sex-based values,

father's education, father's communication with his father, outcome expectations, and

general communication” may all have an effect on parental communication (Lehr et al.,

2005, p. 119).

Auslander, Rosenthal, and Blythe (2006) further stated in their review of literature

that other factors are related to adolescent sexual behaviors. “Adolescents who are

more religious, who are more active in academic activities, and who

have higher academic performances typically delay sexual initiation.

This may be because their religious affiliation provides clear messages

about expectations or because they delay sexual behavior (and other

problem behaviors), suggesting that perhaps these teens also do not

want to jeopardize their futures (e.g., college attendance)” (Auslander,

Rosenthal, & Blythe, 2006, p. 700).

Summary

Sexual health as we understand it today is an essential characteristic of a healthy

adult that is developed during the period of adolescence. The development of sexual

health can be an extremely distressful and potentially harmful time for the adolescent (in
Parent-Adolescent Communication
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terms of engaging in risky behaviors) and therefore requires careful mentoring and

fostering from adult mentors. Adolescents have identified parents as the preferred mentor

and parents and other aspects of the family have the ability to foster the development of

sexual health in many ways, including communication. While the role of communication

in fostering sexual health and curbing sexual behavior is disputed, communication has the

potential to facilitate sexual health if it is done in an open and supportive manner.

Unfortunately, it appears that many parents either do not discuss sexuality related issues

with their children and many of those that do avoid essential topics and conduct

themselves in a manner that is not conducive to proper sexual health. Both adolescents

and parents described various barriers to sexual health, which can be overcome with

proper mentoring and education. Chapter three will provide an overview of the

methodology to be used in this study, including the instrument design and data

collection/analyses method
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CHAPTER 3

METHODS

Overview

This chapter will summarize the methodological protocol that will be used to

complete this study. Topics in this chapter include purpose of the study, research design,

research questions, sample, a detailed description of the instruments (including reliability

information), data collection procedures, and statistical analyses. A summary of the

Sexual Health Inventory and parent-adolescent relationship satisfaction scale pilot study

will be provided.

Purpose of the Study

The purpose of this study is to analyze the relationship between parent-adolescent,

sexuality based communication and sexual health among selected undergraduate students

at a large, mid-western university. Few studies have focused on the effects of parental

communication on other aspects of complete sexual health, such as those described by

Robinson and colleagues (2002) and Bockting et al. (2005). Understanding the role of

parental communication in sexual health development is crucial if health educators desire

to promote and foster sexually healthy adults.

Research Questions

1) What is the overall level of sexual health among selected undergraduate students?

2) What is the level of parent-adolescent sexuality-based communication of selected

undergraduate students?
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3) Do differences exist in reported sexuality-based parent-adolescent communication

among selected undergraduate students based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

4) Do differences exist in sexual health based on gender, socio-economic status,

race/ethnicity, sexual orientation, and religious affiliation?

5) What is the relationship between the style and manner of sexuality-based parental

communication and levels of sexual health?

6) What is the relationship between the general family environment and sexual health?

7) How much variance in overall sexual health can be explained by selected dimensions

of parent-adolescent communication?

Research Design

A descriptive, cross-sectional, correlational design will be employed for this

study. According to Isaac and Michael (1995), descriptive studies are used, “to describe

systematically a situation or area of interest factually and accurately” (p. 46).

Correlational studies are used, “to investigate the extent to which variations in one factor

correspond with variations in one or more other factors based on correlation coefficients”

(p. 46). Further, Isaac and Michael (1995) stated that correlational studies are appropriate

when “variables are complex and/or do not lend themselves to the experimental method

and controlled manipulation. Correlational studies permit the measurement of several

variables and their interrelationships simultaneously and in a realistic setting” (p. 53).

This study will focus on how selected dimensions of parent-adolescent communication

are associated with overall sexual health. Thus, a correlational design is appropriate. A

cross-sectional study is defined as, “a study done at one time, not over the course of time”
Parent-Adolescent Communication
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(Medicinenet.com, 1998). A cross-sectional design was deemed appropriate given that

the sample to be used for this study will only be tested at one particular time. The current

study is retrospective in nature (i.e., selected undergraduate students will recall

conversations held during their adolescence). Retrospective studies assessing parent

adolescent communication have been used successfully in the past (Raffaelli and Green,

2003; Mueller and Powers, 1990) and, therefore, were deemed appropriate for this study.

Sample

The study sample will include a non-random, convenience sample of

undergraduate, male and female students, ages 18-22, enrolled in a personal health course

at a large, mid-western university. This sample was chosen because of (1) the proximity

of the sample to the researcher, (2) access to the sample, and (3) representativeness of a

population who (by this age) will be close to completing sexual development stages

occurring during the period of adolescence, yet are young enough to recall sexuality

based parental communication. The university is located in the Southern Illinois region.

A total of 20,983 students attend the university including 11,537 males (54.98%) and

9,446 females (45.02%) (SIUC, 2007). There are currently 16,193 undergraduate students

enrolled, whose demographics include: 9,249 males (57.1%), 6,944 females (42.9%),

11,176 Caucasians (69.02%), 2,844 African Americans (17.56%), 585 Hispanics

(3.61%), 352 Asians (2.17%), and 1,236 students who identified their country of origin as

“other” (7.63%) (SIUC, 2007). The sample size to be used for this study was determined

using a demographics table produced by Krejcie and Morgan (1970) which was created

from a formula developed by the National Education Association. The table displayed a

known population (N) size and the respective sample size needed.
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The sample size to be used for this study (n = 377) is based on the total number of

undergraduate students enrolled at the university (16,193) since the number of students

ages 18-22 is unknown. The N size of 20,000 was chosen over an N size of 15,000 on

the Krejcie and Morgan (1970) table because, according to Issac and Michael (1995), a

larger sample size will “involve smaller sampling errors, greater reliability, and increase

the power of the statistical test applied to the data” (p. 101). However, in this case,

choosing the larger N size only resulted in an additional two participants, which may not

affect sampling error, reliability, or power of the analyses.

Instrumentation

Two self-report instruments will be used to collect data; the Sexual Health

Inventory and the Parental Communication Assessment Survey. According to McDermott

and Sarvela (1999), “the major advantages of surveys are that they employ a standardized

method of data collection that can be administered to a large sample relatively quickly. In

addition, data analysis is uniform and does not usually require subjective interpretation in

the way that analysis of qualitative data does” (p. 244). Further, the self-report method

was chosen because this method is fairly inexpensive, yields a rapid response rate,

insures validity in instruction, and is highly flexible (McDermott & Sarvela, 1999). Five-

point Likert-type scales or summated ratings scales will be used for all items, excluding

those assessing demographic variables. According to Dignan (1995), summated ratings

refers to a, “a type of attitude measurement is the sum of ratings from all items” (p. 87).

Summated (total scores) will be calculated for each component of the sexual health

model, the sexual health model as a whole, and both communication scales; with higher

scores indicating more positive sexual health and communication scores. Dignan (1995)
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shared that summated ratings approaches are, “more flexible than the equal-interval

method and allows for easier introduction of context into the measurement process…the

person expressing their attitude has more freedom of expression than with an equal

interval approach” (p. 87). Dignan (1995) went on to share the importance of having an

expert panel review scale items to ensure that the depth and breadth of the topics have

been appropriately covered and that each item is appropriate for the context of the topic.

All scales that will be used in this study have been used previously and reviewed by a

variety of individuals in the fields of sexuality and communication.

The Sexual Health Inventory

The Sexual Health Inventory was developed by Edwards, Coleman, and Miner

(2007). The instrument is comprised of 112 items; 104 assessing the ten areas of the

sexual health model (Table 1), 32 sub-components (Table 2), and eight items assessing

demographics of the sample. According to Edwards, Coleman, and Miner (2007), the

instrument was designed from an initial pool of 250 questions after analyzing more than

200 instruments and “a current review of the most recent (1999-2004) literature indexed

in PsycINFO, Social Science Abstracts, and Medline, searching on the key words ‘sexual

health’” (p. 6). Further, unpublished works also were used for the purpose of question

design along with spontaneous questions developed by the instrument designers, which

were deemed appropriate (Edwards, Coleman, and Miner, 2007).


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Table 1
Sexual Health Inventory Items
Component 1: Talking About Sex
Question
I avoid talking about sex.
I talk about my sexuality with my friend(s).
I find many sexual matters too upsetting to talk about.
I talk about my sexuality with my sexual partner(s).
I talk about my sexual feelings.
I usually feel comfortable discussing my sexual values.
I usually feel comfortable discussing topics of a sexual nature.
In general, I usually feel comfortable discussing my sexuality.
Talking about sex is usually a positive experience.
It bothers me to talk about sex.
I usually feel comfortable discussing my sexual behavior.
There will be negative consequences if I talk about sex.

Component 2: Culture and Sexual Identity


Question
My sexual orientation (bisexual, homosexual, heterosexual) is positively valued in my community.
People in my community approve of my sexuality.
My culture has a negative view of sexuality.
My culture has a negative view of homosexuality.
I feel my sexual behavior(s) are consistent with my community’s values.

Component 3: Sexual Anatomy and Functioning


Question
I avoid sex because of problems with sexual functioning.
I have concerns about my sexual functioning.
FOR MEN I have trouble getting or keeping an erection
FOR WOMEN I have trouble getting wet/lubricating.
I think I might have a sexual functioning problem caused by a medical condition or prescribed
medications.
I often have a delay or absence of orgasm when I am with a sexual partner.
I usually am able to orgasm/“come” when I am with my partner(s).
I feel anxious about my ability to perform sexually.
I often have a delay or absence of orgasm when I masturbate.

Component 4: Sexual Health Care and Safer Sex


Question
I fear getting HIV/AIDS or a sexually transmitted disease.
I feel I am at high risk for getting HIV/AIDS or a sexually transmitted disease.
I worry that I might be infected with a sexually transmitted disease.
I want information on sexually transmitted diseases.
I want information on how to practice safer sex.
I worry that I might be infected with HIV.
[ ] check here if you know you are HIV Positive.
I want information on HIV/AIDS.
Parent-Adolescent Communication
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Component 5: Challenges - Overcoming Barriers to Sexual Health


Question
I was sexually abused as a child.
I engage in sexual behaviors that bother me.
I have been sexually abused as an adult.
I feel unable to control my sexual feelings.
I feel unable to control my sexual behavior.
My sexual behavior has caused me relationship difficulties.
I attempted suicide recently.
I feel depressed most of the time.
I feel sad much of the time.
I have considered suicide recently.
I wish I was dead.
I have been physically abused as an adult.
I’ve used sex to avoid problems in my life.
I was physically abused as a child.
My sexual behaviors have caused me financial difficulties.

Component 6: Body Image


Question
In general, I like how my body looks.
I like the look of my genitals.
I like how my breast/chest looks.
I am uncomfortable with several parts of my body.
Overall, I feel my body is attractive.
FOR MEN:I like the size of my penis.
FOR WOMEN: I like the size of my breasts.
I feel I am overweight.

Component 7: Masturbation and Fantasy


Question
I enjoy masturbating.
Masturbation is a good way to affirm my sexuality.
Masturbation is a good way to help me feel better about myself.
Sharing a sexual fantasy with a sexual partner(s) enriches my sex life.
I believe masturbation is sinful.
Sexual fantasy helps me learn about what I like and don’t like sexually.
Masturbation is a healthy way to have sex when I’m horny.
Sharing a sexual fantasy is a good way to get to know what a sexual partner likes.
Masturbation is a good way to get to know what a sexual partner likes.
Masturbation with my sexual partner(s) is a healthy expression of being close to one another.
Masturbation is very safe sex.
I enjoy fantasizing about sex.
Masturbation is a healthy way to learn about my sexual desires.
Masturbation is a positive source of comfort and pleasure.
Masturbation is a form of healthy sexual expression.
Masturbation can be helpful in overcoming sexual dysfunction.
I masturbate to explore my body.
I enjoy hearing about my sexual partner’s sexual fantasies.
Sexual fantasy helps me express my sexual desires.
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Component 7: Masturbation and Fantasy (Continued)


Question
I feel guilty when I masturbate.
Masturbation is a good way to reduce stress.

Component 8: Positive Sexuality


Question
I can explore my sexuality in a positive way.
My sex life is exciting.
My sex life is boring.
I enjoy experimenting with sex to learn about what I like.
My sexuality is a positive force of my life.
I know what kinds of sexual behaviors I like.
My sexuality makes me feel good about my life.
Having a good sex life is an important part of my life.
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Component 9: Intimacy and Relationships


Question
Talking about sex with my sexual partner(s) is a satisfying experience.
[ ] Check here if no current sexual partner(s).
Overall, I feel satisfied about my current sexual relationship(s).
[ ] Check here if no current sexual relationship(s).
I have difficulty finding a sexual partner.
I feel my sexual partner(s) avoids talking about sexuality with me.
[ ] Check here if no current sexual partner(s).
When I have sex with my sexual partner, I feel emotionally close to him or her.
Overall, I feel close with my sexual partner(s).
[ ] Check here if no current sexual partner(s).
I have difficulty keeping a sexual partner.
I feel I can express what I like and don’t like sexually.
I feel my sexual partner(s) is sensitive to my needs and desires.
[ ] Check here if no current sexual partner(s).
Some sexual matters are too upsetting to discuss with my partner(s).

Component 10: Spirituality and Values


Question
I have strong religious beliefs.
I often attend religious services.
My spiritual beliefs affirm my sexuality.
I am a very religious person.
Sex is a sacred/holy act.
Sexuality helps me feel connected to God.
I am affirmed in my sexuality by my higher power.
My spirituality is very important for me in how I view my sexuality.
I have strong spiritual beliefs.
I am a very spiritual person.
Sexual behavior is an expression of God’s love in my life.

Source: Edwards, Coleman, and Miner (2007, pp. 29-32)


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Table 2
Elements of Sexual Health described in the Sexual Health Inventory
_______________________________________________________________________
_
Component Sub-Components
Talking About Sex (a) Fear of talking about sex
(b) Comfort talking about sex
(c) Behavior

Culture and Sexuality (a) General questions about culture and sexuality
(b) Culture and homosexuality
(c) Perceived level of congruence between their sexual
behavior and their culture

Sexual Anatomy and (a) Sexual Functioning


Functioning (b) Fear or self-perception of sexual dysfunction

Sexual Healthcare and (a) Fear or perceived vulnerability of STI/HIV transmission


Safer Sex (b) STI transmission risk
(c) Desire for information about HIV and other STI’s

Overcoming barriers (a) Physical and sexual abuse as a child and as an adult
to sexual health (b) Compulsive sexual behavior
(c) Mental health

Body Image (a) Global self-assessment of body image


(b) Self-assessments of specific body parts

Masturbation and (a) Masturbation as affirming to self


Fantasy (b) Masturbation as safe sex
(c) Masturbation as a way to affirm a relationship
(d) Guilt about masturbating
(d) Fantasy as a way to enrich a relationship
(f) Fantasy as a method for self-discovery, enjoyment and
self-expression

Positive Sexuality (a) Current sexual satisfaction


(b) Self-rating of the importance of sexual expression in
one’s life
(c) Self-assessment to explore and experiment sexually

Intimacy and (a) Communication with a partner regarding sexuality and


Relationships other emotional disclosures
(b) Feelings of closeness with one’s sexual partner
(c) Ability to keep or find a sexual partner
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(d) Satisfaction in the relationship
_______________________________________________________________________
_
_______________________________________________________________________
_
Component Sub-Components (Continued)
Spirituality and (a) Spirituality
Values (b) Religiosity
(c) Sex as a gift
_______________________________________________________________________
_

Source: Edwards, Coleman, and Miner (2007)

According to Edwards, Coleman, and Miner (2007), the instrument was reviewed

by a panel of sexuality experts, who used three criteria to evaluate the instrument: “(1)

accuracy in reflecting the Sexual Health Model, (2) clarity in wording, and (3) ability to

provide helpful information in a clinical or research setting” (p. 6).

The Sexual Health Inventory was first pilot tested using 15 colleagues of the

researcher, for the purpose of examining the instrument for potential flaws (Edwards,

Coleman, and Miner, 2007). A larger study (n = 937), using a non-random, convenience

sample, was conducted to run appropriate statistical analyses (Edwards, Coleman, and

Miner, 2007).

Pilot study participants ranged from 18 to 74 years of age (M = 36.6; SD = 12.8)

(Edwards, Coleman, and Miner, 2007). More than half (57%) were male; 41% were

female; and 1% were transgender (Edwards, Coleman, and Miner, 2007). The majority of

the participants identified themselves as homosexual (52%), indicating a skewed sample,

based on national statistics. The remainder were comprised of heterosexual (34%) and bi-

sexual (14%). Results indicated that the sample was well educated with 94% having some

college experience, a college degree, and/or graduate school experience. In terms of race
Parent-Adolescent Communication
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and ethnicity, the pilot sample primarily were composed of Caucasians (93%); the

remainder were Black/African American, Asian, American Indian/Alaska Native, and

Hawaiian/Pacific Islander. Three percent of the sample indicated they were Hispanic or

Latino/Latina (Edwards, Coleman, and Miner, 2007).

The survey was completed by 1,390 individuals, however, 453 surveys were

removed from the pool because they did not meet the standards set by the researchers.

Similar standards also will be implemented in the current study. These criteria included:

1) No more than 5% answers were missing. For analysis, missing data were

replaced by the mean score for that item.

2) No obvious response sets were found (e.g., the subject marked “unsure” for

every answer)

Source: (Edwards, Coleman, and Miner, 2007, p. 9)

According to Edwards, Coleman, and Miner (2007), “reliability analysis was

employed as a preliminary method of identifying items that consistently measure each

subscale. Of the 187 original items, 104 items remained after the reliability analysis” (p.

12). Cronbach alpha (internal reliability scores) for the 10 components of sexual health

ranged from 0.77-0.93 (Edwards, Coleman, and Miner, 2007).

Factor analyses indicated that the “majority of the inter-scale correlations from

the factor analysis are low to moderate, but there were exceptions” (Edwards, Coleman,

and Miner, 2007, p. 18). Overall, data analyses indicated the survey accurately reflected

the sexual health model and was statistically sound.

A pilot study was conducted at the sample university using two Foundations of

Health Education (HED 101) courses (n = 21). The pilot sample was comprised of 61.9%
Parent-Adolescent Communication
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male; Caucasian (57.1%), heterosexual (81.0%), Christian (85.7%) students. A summary

of the pilot sample demographics can be found in Table 3. Internal reliability estimates

(coefficient alpha or Cronbach’s alpha) were calculated for each of the ten components of

sexual health and total sexual health. Cronbach alpha scores ranged from 0.361 – 0.953

(see Table 4). Descriptive statistics for the components of sexual health can be found in

Table 5. These analyses were conducted using only those participants who answered all

items on each scale. Descriptive statistics for individual scale items can be found in

Appendix A.

Two components, ‘Culture and Sexual Identity’ and ‘Sexual Health Care and

Safer Sex’ yielded Cronbach alpha coefficients below 0.70, indicating low internal

consistency reliability. These coefficients may be different from those in the original pilot

study for various reasons. The current pilot study consisted of a total of 21 individuals,

whereas Edwards, Coleman, and Miner had a sample exceeding 900 individuals. Further,

the original pilot study contained a large number of homosexual and transgender

individuals, which may have affected responses for component two (Culture and Sexual

Identity). Items in component two assessed whether homosexuality and sexual orientation

in general were valued in one’s community/culture. Because homosexual individuals

form their own “community” and “culture” they may provoke more favorable responses

compared to other cultures/communities where homosexuality is not valued. Component

four (Sexual Health Care and Safer Sex) contained questions assessing fear and risk

associated with HIV and STI’s as well as questions related to the desire for more

information on STI’s, safer sex, and HIV.


Parent-Adolescent Communication about Sex 100

Table 3
Demographics of the Pilot; Gender, Age, Year in School, Race, Ethnicity, Sexual Orientation, SES, and Religious Affiliation (n = 21)

Demographic Variable Frequency (n) Percentage (%) Demographic Variable Frequency (n) Percentage (%)

Gender Sexual Orientation


Male 13 61.9 Heterosexual 17 81.0
Female 8 38.1 Bisexual 2 9.5
Age Homosexual 1 4.8
18 2 9.5 Other 1 4.8
19 6 28.6 SES*
20 2 9.5 Low 1 4.8
21 2 9.5 Not low 16 76.2
22 9 42.9 Unknown 4 19.0
Year in School Religious Affiliation
Freshman 4 19.0 Catholic 8 38.1
Sophomore 6 28.6 Christian (Other) 10 47.6
Junior 4 19.0 Jewish 0 0
Senior 7 33.3 Muslim 1 4.8
Race Buddhist 0 0
Caucasian 12 57.1 Agnostic 2 9.5
Black 7 33.3 Atheist 0 0
Asian/Pacific Islander 1 4.8 Other 0 0
Native American 0 0
Other 1 4.8
Ethnicity
Hispanic 2 9.5
Non-Hispanic 19 90.5
* Refers to SES during adolescent years
* Those students who indicated that their family was eligible for public assistance was placed in ‘Low’ SES
Parent-Adolescent Communication about Sex 101

Table 4
Cronbach Alpha Scores for the Sexual Health Model

Component Cronbach’s Alpha Number of items


Talking About Sex 0.897 12

Culture & Sexual Identity 0.361 5

Sexual Anatomy & 0.739 8


Functioning

Sexual Health Care & Safer 0.491 7


Sex

Overcoming Barriers to 0.953 15


Sexual Health

Body Image 0.713 7

Masturbation & Fantasy 0.948 21

Positive Sexuality 0.814 8

Intimacy & Relationships 0.824 10

Spirituality & Values 0.896 11

TOTAL SHM 0.762 104

This mixture of non-attitudinal questions (i.e. wanting more information) and risk

assessment may have caused the Cronbach score to fall below acceptable levels.

The total sexual health model yielded a Cronbach alpha score of 0.762,

confirming internal reliability. The decision was made to maintain the ‘Culture and

Sexual Identity’ and ‘Sexual Health Care and Safer Sex’ components because (1) their

inclusion in the sexual health model did not affect reliability scores enough to bring the

total model below acceptable levels and (2) the instrument was designed to assess total

sexual health, including these two areas. Their removal would therefore leave out key

aspects of sexual health and, therefore, not reflect total sexual health.
Parent-Adolescent Communication about Sex 102
Table 5
Descriptive Statistics for Components of the Sexual Health Model

Component n Possible Mean Std. Deviation Variance Range Min Max


Scores
Talking about Sex 1 12-60 48.00 7.94 63.00 32.00 27.00 59.00
9

Culture and Sexual Identity 2 5-25 17.76 2.88 8.29 15.00 9.00 24.00
1

Sexual Anatomy and Functioning 2 8-40 33.86 5.09 25.93 22.00 18.00 40.00
1

Sexual Health Care and Safer Sex 2 7-35 25.62 3.77 14.25 15.00 17.00 32.00
1

Overcoming Barriers to Sexual 2 15-75 65.67 12.76 162.93 51.00 24.00 75.00
Health 1

Body Image 1 7-35 25.68 4.68 21.90 18.00 14.00 32.00


9

Masturbation and Fantasy 2 21-105 75.14 15.94 253.93 60.00 42.00 102.00
1

Positive Sexuality 2 8-40 30.33 5.66 32.03 24.00 14.00 38.00


1

Intimacy and Relationships 1 10-50 39.22 6.91 47.71 41.00 8.00 49.00
8

Spirituality and Values 2 11-55 33.19 9.75 95.06 35.00 20.00 55.00
Parent-Adolescent Communication about Sex 103
1

Total Sexual Health 1 104-520 399.4 20.83 433.77 208.0 232.0 440.00
3 6 0 0
Parent-Adolescent Communication about Sex 104

Further, when a Cronbach alpha was computed on the sexual health model without

components two and four, the alpha score was only raised by 0.002 from 0.762 to 0.764.

Parental Communication Assessment Survey

The Parental Communication Assessment Survey was designed to assess two of

five components of communication, described by Jaccard, Dittus, and Gordon (1998)

including, (1) the style or manner in which information is communicated, and (2) the

general family environment (i.e. the overall quality of the relationship between parent and

teen) in which the communication takes place). The scale assessing the style or manner in

which the information is communicated was used previously by Miller, Kotchick,

Dorsey, Forehand and Ham (1998) and Dutra, Miller, and Forehand (1999). The scale

consists of 10, five-point Likert-type scale items, including:

My mother doesn’t know enough about topics like this to talk to me

My mother wants to know my questions about these topics

My mother tries to understand how I feel about these topics

When my mother talks to me about these topics, she warns or threatens me about the

consequences

My mother knows how to talk to me about topics like this

I can ask my mother the questions I really want to know about topics like this

My mother and I talk openly and freely about these topics

My mother tells me things about these topics that I already know

If I talked to my mother about these topics, she would think I’m doing these things

My mother doesn’t talk to me about these topics; she lectures me

(Source: Miller, Kotchick, Dorsey, & Forehand, 1998)


The original scale was used with adolescents and only referred to maternal
Parent-Adolescent Communication about Sex 105

communication. For the purpose of this study, the scale will be given twice; one for each

parent/legal guardian. The original scale used a four-point Likert-type scale system,

however, a five-point Likert-type scale system will be used for this study to maintain

consistency throughout the instrument; thus avoiding confusion. An internal reliability

estimate (coefficient alpha) yielded scores ranging from of 0.72-0.79, depending on

whether the instrument was given to adolescents or adults (Miller, Kotchick, Dorsey, &

Forehand, 1998; Dutra, Miller, & Forehand, 1999). Appropriate items will be reversed

coded so that higher scores will indicate more positive, open, and receptive

communication. A pilot study using this scale was not conducted along with the other

scales because this scale was not discovered until after the completion of the pilot.

The scale assessing overall quality of the relationship between the parent and teen

was developed by Jaccard, Dittus, and Gordon (2000). The scale was designed to assess

the “adolescent’s satisfaction with his/her relationship, specifically with their mothers”

(Jaccard, Dittus, and Gordon, 2000, p. 191). Using a scale that assessed relationship

satisfaction through the viewpoint of the adolescent seemed appropriate since this study

will be examining the relationship between participants and their parents, as described by

the participant. However, the scale also was used with mothers (Jaccard, Dittus, and

Gordon, 2000). The scale consisted of 11, five-point Likert-type scale items (from

strongly disagree – strongly agree) including:

I am satisfied with the way my mother and I communicate with each other

I am satisfied with the love and affection my mother shows me

I am satisfied with the emotional support my mother provides me

I am satisfied with how many things my mother and I have in common


Parent-Adolescent Communication about Sex 106

I am satisfied with the household responsibilities my mother gives me

I am satisfied with the way my mother disciplines me

I am satisfied with the amount of time my mother and I spend together

I am satisfied with the way my mother and I resolve our conflicts

I am satisfied with the respect my mother shows me

I am satisfied with the fun my mother and I have together

I am satisfied with the relationship I have with my mother

(Source: Jaccard, Dittus, and Gordon, 2000, p. 191)

“An internal reliability coefficient (coefficient alpha) yielded a score of 0.90 when

given to adolescents and a score of 0.89 when given to mothers” (Jaccard, Dittus, and

Gordon, 2000, p. 191). A pilot study was also conducted at the sample university (n =

20), yielding a Cronbach alpha coefficient of 0.952. Descriptive statistics for individual

scale items can be found in Appendix B. Consistent with the scale assessing openness of

communication, the scale assessing relationship satisfaction will be administered twice;

one for each parent/legal guardian. The wording will be changed from present to past

tense. Higher scores will indicate that subjects were more satisfied with their relationship

with their parents. The final instrument consists of 154 items. Permission to use all scales

was provided via personal communication with the original developer or co-author.

Items assessing demographics will be placed at the end of the instrument and

consist of multiple choice items. McDermott & Sarvela (1999) stated that when

demographic questions are placed at the beginning of the instrument, “the potential

respondent may find the questions boring or too personal and thus, be less likely to

complete the remaining questions. When demographic questions are at the end, the
Parent-Adolescent Communication about Sex 107

respondent has already vested time in completing the survey, and therefore, is more likely

to answer the demographic questions and return the survey” (p. 254).

Data Collection

Instruments will be distributed (after Human Subjects approval) to students

attending selected undergraduate courses at a large, mid-western university. Classes will

be selected in a convenience, non-random manner. According to McDermott and Sarvela

(1999), convenience samples “permit the investigator to collect a large amount of

information, from a large number of people, and in a relatively small amount of time” (p.

267). Further, McDermott and Sarvela (1999) also stated that convenience samples are

useful when the issue or research topic at hand has not been previously explored. A

convenience sample seems appropriate given that research related to parental-

communication and overall sexual health has not (to the knowledge of the researcher)

been explored. Permission to request participants from instructors was provided by the

teaching assistant coordinator of the selected sample classes. Instructors of classrooms

where instruments will be contacted (by phone, personal visit, or email) and consent will

be obtained to use their classrooms to distribute instruments. The researcher will follow a

supervised format where he will explain the purpose of the study, read the scripted

directions, and supply students with instruments, writing utensils, and informed consent

documents. According to McDermott and Sarvela (1999), “a supervised format is

preferred because it allows for consistent instructions, simultaneous administration,

availability to answer questions, and the monitoring of completion” (p. 251). Upon

receiving permission, the researcher will distribute instruments, informed consent

documents, and scantron sheets to students. The researcher will read the informed
Parent-Adolescent Communication about Sex 108

consent survey aloud along with appropriate directions to complete the instrument.

Students will be instructed to detach the informed consent document to use to cover their

answers on the scantron. A manila envelope will be available in the front of the

classroom for students to place completed surveys. Students will be free to have any

questions answered during the survey. Upon completion, surveys will be taken to the

home of the researcher and stored in a secure location.

Data Analyses

All statistical analyses will be conducted using the Statistical Package for the

Social Sciences (SPSS) 16.0. Descriptive statistics, including frequencies and percentages

as well as measures of central tendency and dispersion (statistical means, standard

deviation, and range) will be calculated for each item on the instrument. Demographic

data will include gender, age, socio-economic status (determined by participants

indicating whether they were eligible for a free/reduced lunch), race/ethnicity, sexual

orientation, and religious affiliation. Frequencies, percentages and measures of central

tendency and dispersion also will be calculated for each of the ten components of sexual

health, the total sexual health model, and parent-adolescent communication. Parental

communication will be analyzed separately for mother/female authority figure and

father/male authority figure rather than combining them together in one parental variable.

Separating the gender of the parent will allow for deeper analysis and more thorough

data. Missing entries will be replaced with the mean score of the item.

Pearson product-moment coefficients will be used to determine (1) the

relationship between overall sexual health and the selected components of parental

communication and (2) the relationships between components of parental communication


Parent-Adolescent Communication about Sex 109

(separate analyses for gender of parent/guardian) and the ten individual components of

the sexual health model. McDermott & Sarvela (1999) stated that “correlational

procedures are used to study the strength and direction of the relationships between the

two variables” (p. 303). According to Isaac and Michael (1995), the Product-Moment

Correlation Coefficient (Pearson r) is appropriate when assessing the relationship

between two raw scores or “continuous variables” (p. 174).

A series of ANOVA’s and independent sample t-tests will be utilized to assess

differences in sexual health and parental communication (separate analyses for gender of

parent/guardian) between socio-economic status, race/ethnicity, sexual orientation, and

religious affiliation. Finally, a multiple regression analysis will be used to determine the

variance in overall sexual health that can be explained by selected dimensions of parent-

child communication. A summary of the scoring and statistical analyses to be used can be

found Tables 6 and 7.


Parent-Adolescent Communication about Sex 110

Table 6
Instrument Scoring Method

Instrument Scoring
Sexual Health Inventory 1) Total Sexual Health Score
- Combined score of all ten components of the Sexual Health Model
- Raw score; higher scores indicate more positive sexual health
- Likert-type Scale: (1=SD; 2=D; 3=U; 4=A; 5=SA (reverse coded when
necessary)
2) Ten components of the Sexual Health Model
-Total score of the individual items in each component
- Raw score for each component; higher scores indicate more positive
sexual health
- Likert-type Scale: (1=SD; 2=D; 3=U; 4=A; 5=SA (reverse coded when
necessary)
Parental Communication 1) Two components of parental communication
Assessment Survey (A) Style or manner in which information is
Communicated
(B) General family environment (i.e. the overall
quality of the relationship between parent and teen)
in which the communication takes place).
- Two separate total scores from the questions in each component; one for
the father/male authority figure and on for mother/female authority figure
- Raw scores for each component; higher scores indicated a
positive/conducive style of communication and a stronger family
environment respectively
- Likert-type Scale: (1=SD; 2=D; 3=U; 4=A; 5=SA (reverse coded when
necessary)
Parent-Adolescent Communication about Sex 111

Table 7
Statistical Analyses Summary

Research Question Data Collection Data Analysis


What is the overall sexual health - Total Sexual Health Score - Descriptive statistics for
of selected undergraduate - Ten components of the the Total Sexual Health
students? Sexual Health Model Score, the ten
scores components of sexual
health, and individual items
What is the level of parent- Two components of - Descriptive statistics for
adolescent sexuality-based parental communication components of parental
communication of selected - Mother and father will be communication and individual
undergraduate students? analyzed separately items

Do differences exist in reported - Two components of 1) Gender


sexuality based parental parental communication - t-test
communication among selected - Mother and father will be 2) Socio-economic status*
undergraduate students based on analyzed separately - t-test
gender, socio-economic status, 3) Race/Ethnicity
race/ethnicity, sexual orientation, - ANOVA
and religious affiliation? 4) Sexual Orientation
- ANOVA
5) Religious Affiliation
- ANOVA
Do differences exist in sexual - Total Sexual Health Score 1) Gender
health based on gender, socio- - Ten components of the - t-test
economic status, race/ethnicity, Sexual Health Model 2) Socio-economic status*
sexual orientation, and religious scores - ANOVA
affiliation? 3) Race/Ethnicity
- ANOVA
4) Sexual Orientation
- ANOVA
5) Religious Affiliation
- ANOVA
What is the relationship between - Total Sexual Health Score - Pearson Product Moment
the style and manner of sexuality - Parental communication Correlation
based parental communication (A) The style or manner
and sexual health status? in which information is
communicated
- Mother and father will be
analyzed separately
What is the relationship between - Total Sexual Health Score - Pearson Product Moment
the general family environment - Parental communication Correlation
and sexual health status? (B) The general family
environment
- Mother and father will be
analyzed separately
How much variance in overall - Total Sexual Health Score - Multiple Regression Analysis
sexual health can be explained by - Two components of
selected dimensions of parent- parental communication
adolescent communication? - Mother and father will be
analyzed separately
Parent-Adolescent Communication about Sex 112

* SES will be determined by eligibility for free/reduced-price school lunch during


adolescence

Summary

The purpose of this study is to analyze the relationship between parent-adolescent,

sexuality based communication and sexual health among selected undergraduate students

at a large, mid-western university. A retrospective, cross-sectional, correlational designed

will be utilized for this study. A total of 377 undergraduate at SIUC will complete two

self-report instruments. The instruments are comprised of three scales used to assess

sexual health, the style/manner of communication, and quality of the relationship

between parent and adolescent. Selected undergraduate students, ages 18-22, will be

solicited to complete the instrument. The instruments are comprised of a total of 154

items, consisting of primarily five-point Likert-type scale items (1 – Strongly Disagree; 2

– Disagree; 3 – Unsure; 4 – Agree; 5 – Strongly Agree) with appropriate questions being

reversed coded. Higher scores indicate more positive sexual health, more open/receptive

communication, and a stronger parent-child relationship. A series of descriptive statistics,

independent sample t-tests, Pearson product moment correlations, ANOVA’s, and

multiple regression analyses will be used to answer the research questions. Chapters four

and five will give a detailed account of the findings of the study and appropriate

conclusions and recommendations.


Parent-Adolescent Communication about Sex 113

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Parent-Adolescent Communication about Sex 125

APPENDIXES
Parent-Adolescent Communication about Sex 126

Appendix A

Pilot Study Descriptive Statistics for Individual Items in the Sexual Health Inventory

Item n SD D U A SA Mean Std Variance


n(%) n(%) n(%) n(%) n(%) Dev
Component 1: Talking About Sex
There will be negative consequences if I talk about sex 2 13(61.9) 7(33.3) 0(0.0) 0(0.0) 1(4.8) 4.48 0.93 0.86
1
I find many sexual matters too upsetting to talk about* 2 10(47.6) 10(47.6) 1(4.8) 0 (0.0) 0 (0.0) 4.43 0.60 0.36
1
It bothers me to talk about sex* 2 10(47.6) 10(47.6) 0(0.0) 1(4.8) 0(0.0) 4.38 0.74 0.55
1
I avoid talking about sex* 2 6 (28.6) 15(71.4) 0(0.0) 0 (0.0) 0 (0.0) 4.29 0.46 0.21
1
I talk about my sexuality with my friends 2 1 (4.8) 1 (4.8) 1(4.8) 12(57.1) 6(28.6) 4.00 1.00 1.00
1
I usually feel comfortable discussing my sexual values 2 2 (9.5) 0 (0.0) 1(4.8) 12(57.1) 6(28.6) 3.95 1.12 1.25
1
I usually feel comfortable discussing topics of a sexual 2 1(4.8) 1(4.8) 0(0.0) 15(71.4) 4(19.0) 3.95 0.92 0.85
nature 1
In general, I usually feel comfortable discussing my 2 1(4.8) 2(9.5) 0(0.0) 12(57.1) 6(28.6) 3.95 1.07 1.15
sexuality 1
Talking about sexuality is usually a positive experience 2 0(0.0) 1(4.8) 3(14.3) 13(61.9) 4(19.0) 3.95 0.74 0.55
1
I usually feel comfortable discussing my sexual behavior 2 1(4.8) 1(4.8) 2(9.5) 11(52.4) 5(23.8) 3.90 1.02 1.04
0
I talk about my sexual feelings 2 2 (9.5) 1 (4.8) 1(4.8) 13(61.9) 4(19.0) 3.76 1.14 1.29
1
I talk about my sexuality with my sexual partners 2 3 (14.3) 1 (4.8) 0(0.0) 12(57.1) 4(19.0) 3.65 1.31 1.71
0
Component 2: Culture and Sexual Identity
Parent-Adolescent Communication about Sex 127

My sexual orientation is positively valued in my 2 1(4.8) 0(0.0) 2(9.5) 8(38.1) 10(47.6) 4.24 1.00 0.99
community 1
Parent-Adolescent Communication about Sex 128

Item n SD D U A SA Mean Std Variance


n(%) n(%) n(%) n(%) n(%) Dev
People in my community approve of my sexuality
2 0(0.0) 1(4.8) 2(9.5) 9(42.9) 9(42.9) 4.24 0.83 0.69
1
My culture has a negative view of sexuality* 2 4(19.0) 9(42.9) 4(19.0) 2(9.5) 2(9.5) 3.52 1.21 1.46
1
I feel my sexual behaviors are consistent with my 2 1(4.8) 4(19.0) 4(19.0) 7(33.3) 5(23.8) 3.52 1.21 1.46
community’s values 1
My culture has a negative view of homosexuality* 2 1(4.8) 1(4.8) 7(33.3) 5(23.8) 7(33.3) 2.24 1.14 1.29
1
Component 3: Sexual Anatomy & Functioning
FOR MEN, I have trouble getting or keeping an erection; 2 17(81.0) 4(19.0) 0(0.0) 0(0.0) 0(0.0) 4.81 0.40 0.53
FOR women, I have trouble getting wet/lubricated* 1
I think I might have a sexual functioning problem caused 2 16(76.2) 4(19.0) 0(0.0) 1(4.8) 0(0.0) 4.67 0.73 0.53
by a medical 1
condition or prescribed medications*
I avoid sex because of problems with sexual functioning* 2 13(61.9) 6(28.6) 0(0.0) 2(9.5) 0(0.0) 4.43 0.93 0.86
1
I have concerns about my sexual functioning* 2 11(52.4) 7(33.3) 1(4.8) 1(4.8) 1(4.8) 4.24 1.09 1.19
1
I often have a delay or absence in orgasm when I 2 11(52.4) 7(33.3) 1(4.8) 1(4.8) 1(4.8) 4.24 1.09 1.19
masturbate* 1
I usually am able to orgasm/come why I am with my 2 1(4.8) 2(9.5) 1(4.8) 6(28.6) 11(52.4) 4.14 1.20 1.43
partners 1
I often have a delay or absence of orgasm when I 2 8(38.1) 7(33.3) 4(19.0) 1(4.8) 1(4.8) 3.95 1.12 1.25
masturbate* 1
I feel anxious about my ability to perform sexually* 2 7(33.3) 6(28.6) 0(0.0) 4(19.0) 4(19.0) 3.38 1.60 2.55
1
Component 4: Sexual Health Care & Safer Sex
I worry that I might be infected with HIV 2 13(61.9) 8(38.1) 0(0.0) 0(0.0) 0(0.0) 4.62 0.50 0.25
1
Item n SD D U A SA Mean Std Variance
Parent-Adolescent Communication about Sex 129

n(%) n(%) n(%) n(%) n(%) Dev


I worry I might be infected with an STD 2 12(57.1) 8(38.1) 1(4.8) 0(0.0) 0(0.0) 4.52 0.60 0.36
1
I feel I am at high risk for getting HIV/AIDS 2 9(42.9) 10(47.6) 0(0.0) 1(4.8) 1(4.8) 4.19 1.03 1.06
1
I want more information on how to practice safer sex 2 5(23.8) 7(33.3) 1(4.8) 7(33.3) 1(4.8) 3.38 1.32 1.75
1
I want more information on STD’s 2 3(14.3) 9(42.9) 1(4.8) 6(28.6) 2(9.5) 3.24 1.30 1.69
1
I want more information on HIV/AIDS and other STD’s 2 3(14.3) 8(38.1) 3(14.3) 5(23.8) 2(9.5) 3.24 1.26 1.59
1
I fear getting HIV/AIDS or STD’s 2 0(0.0) 7(33.3) 1(4.8) 7(33.3) 6(28.6) 2.43 1.25 1.56
1
Component 5: Challenges – Overcoming Barriers to
Sexual Health
I wish I was dead 2 15(71.4) 5(23.8) 0(0.0) 1(4.8) 0(0.0) 4.62 0.74 0.55
1
I attempted suicide recently 2 17(81.0) 2(9.5) 0(0.0) 1(4.8) 1(4.8) 4.57 1.08 1.16
1
I have been sexually abused as an adult 2 15(71.4) 4(19.0) 0(0.0) 2(9.5) 0(0.0) 4.52 0.93 0.86
1
My sexual behaviors have caused me financial difficulties 2 16(76.2) 3(14.3) 0(0.0) 0(0.0) 2(9.5) 4.48 1.21 1.46
1
I was sexually abused as a child 2 13(61.9) 4(19.0) 3(14.3) 1(4.8) 0(0.0) 4.38 0.92 0.85
1
I engage in sexual behaviors that bother me 2 13(61.9) 6(28.6) 0(0.0) 1(4.8) 1(4.8) 4.38 1.07 1.15
1
I feel unable to control my sexual behavior 2 13(61.9) 6(28.6) 0(0.0) 1(4.8) 1(4.8) 4.38 1.07 1.15
1
I have considered suicide recently 2 14(66.7) 5(23.8) 0(0.0) 0(0.0) 2(9.5) 4.38 1.20 1.45
1
I have been physically abused as an adult 2 14(66.7) 5(23.8) 0(0.0) 0(0.0) 2(9.5) 4.38 1.20 1.45
1
I was physically abused as a child 2 14(66.7) 5(23.8) 0(0.0) 0(0.0) 2(9.5) 4.38 1.20 1.45
Parent-Adolescent Communication about Sex 130

1
I’ve used sex to avoid problems in my life 2 13(61.9) 5(23.8) 1(4.8) 1(4.8) 1(4.8) 4.33 1.11 1.23
1
I feel unable to control my sexual feelings 2 12(57.1) 7(33.3) 0(0.0) 1(4.8) 1(4.8) 4.33 1.06 1.13
1
I feel depressed most of the time 2 11(52.4) 7(33.3) 1(4.8) 1(4.8) 1(4.8) 4.24 1.09 1.19
1
I feel sad much of the time 2 11(52.4) 7(33.3) 0(0.0) 2(9.5) 1(4.8) 4.19 1.17 1.36
1
My sexual behavior has caused me relationship difficulties 2 10(47.6) 8(38.1) 0(0.0) 1(4.8) 2(9.5) 4.10 1.26 1.59
1

Item n SD D U A SA Mean Std Variance


n(%) n(%) n(%) n(%) n(%) Dev
Component 6: Body Image
For Me, I like the size of my penis; for women I like the 2 0(0.0) 2(9.5) 2(9.5) 9(42.9) 8(38.1) 4.10 0.94 0.89
size of my Breasts 1
Overall, I feel my body is attractive 2 0(0.0) 3(14.3) 3(14.3) 10(47.6) 5(23.8) 3.81 0.98 0.96
1
I like how my breast/chest looks 2 1(4.8) 2(9.5) 3(14.3) 12(57.1) 3(14.3) 3.67 1.02 1.03
1
I feel I am overweight* 2 7(33.3) 6(28.6) 0(0.0) 8(38.1) 0(0.0) 3.57 1.33 1.76
1
In general, I like how my body looks 2 0(0.0) 5(23.8) 3(14.3) 9(42.9) 3(14.3) 3.50 1.05 1.12
0
I like the look of my genitals 2 0(0.0) 4(19.0) 4(19.0) 11(52.4) 1(4.8) 3.45 0.89 0.79
0
I am uncomfortable with several parts of my body* 2 3(14.3) 9(42.9) 4(19.0) 2(9.5) 3(14.3) 3.33 1.28 1.63
1
Component 7: Masturbation & Fantasy
Masturbation is very safe 2 0(0.0) 0(0.0) 4(19.0) 8(38.1) 9(42.9) 4.23 0.77 0.59
1
Sharing a sexual fantasy is a good way to get to know 2 0(0.0) 0(0.0) 4(19.0) 11(52.4) 6(28.6) 4.10 1.17 1.36
Parent-Adolescent Communication about Sex 131

what a partner likes 1


I believe masturbation is sinful* 2 8(38.1) 7(33.3) 4(19.0) 2(9.5) 0(0.0) 4.00 1.00 1.00
1
I enjoy hearing about my sexual partners fantasies 2 1(4.8) 0(0.0) 4(19.0) 11(52.4) 5(23.8) 3.90 1.30 1.69
1
I enjoy fantasizing about sex 2 2(9.5) 1(4.8) 1(4.8) 11(52.4) 6(28.6) 3.86 1.20 1.43
1
Sexual fantasy helps me express my sexual desires 2 1(4.8) 0(0.0) 3(14.3) 14(66.7) 3(14.3) 3.86 0.85 0.73
1
Masturbation is a form of healthy sexual expression 2 1(4.8) 0(0.0) 6(28.6) 9(42.9) 5(23.8) 3.81 0.98 0.96
1
Sexual fantasy helps me learn about what I like and don’t 2 1(4.8) 0(0.0) 4(19.) 13(61.9) 3(14.3) 3.81 0.87 0.76
like Sexually 1
Masturbation is a healthy way to learn my sexual desires 2 1(4.8) 0(0.0) 6(28.6) 10(47.6) 4(19.0) 3.76 0.94 0.89
1
Masturbation is a positive source of comfort and pleasure 2 1(4.8) 2(9.5) 5(23.8) 8(38.1) 5(23.8) 3.67 1.11 1.23
1

Item n SD D U A SA Mean Std Variance


n(%) n(%) n(%) n(%) n(%) Dev
Sharing a sexual fantasy with my partner enriches my sex
life 2 3(14.3) 1(4.3) 4(19.0) 7(33.3) 6(28.6) 3.57 1.36 1.86
1
I enjoy masturbating 2 0(0.0) 5(23.8) 3(14.3) 9(42.9) 4(19.0) 3.57 1.08 1.16
1
Masturbation is a good way to get to know what a sexual 2 2(9.5) 299.5) 4(19.0) 9(42.9) 4(19.0) 3.52 1.21 1.46
partner likes 1
I feel guilty when I masturbate* 2 3(14.3) 10(47.6) 4(19.0) 3(14.3) 1(4.8) 3.52 1.08 1.16
1
Masturbation with my sexual partner is a healthy 2 2(9.5) 5(23.8) 2(9.50 9(42.9) 3(14.3) 3.29 1.27 1.61
expression of being close to one another 1
Masturbation is a good way to reduce stress 2 3(14.3) 2(9.5) 5(23.8) 8(38.1) 3(14.3) 3.29 1.27 1.61
1
Masturbation can be helpful in overcoming sexual 2 2(9.5) 1(4.8) 9(42.9) 8(38.1) 1(4.8) 3.24 1.00 0.99
Parent-Adolescent Communication about Sex 132

dysfunction 1
Masturbation is a healthy way to have sex when I’m horny 2 2(9.5) 4(19.0) 5(23.8) 8(38.1) 2(9.5) 3.19 1.17 1.36
1
I masturbate to explore my body 2 3(14.3) 5(23.8) 2(9.5) 9(42.9) 2(9.5) 3.10 1.30 1.69
1
Masturbation is a good way to affirm my sexuality 2 2(9.5) 4(19.0) 6(28.6) 8(38.1) 1(4.8) 3.09 1.09 1.19
1
Masturbation is a good way to help me feel better about 2 5(23.8) 4(19.0) 4(19.0) 7(33.3) 1(4.8) 2.76 1.30 1.69
myself 1
Component 8: Positive Sexuality
I can explore my sexuality in a positive way 2 1(4.8) 1(4.8) 0(0.0) 13(61.9) 6(28.6) 4.10 0.89 0.79
1
I enjoy experimenting with sex to learn about what I like 2 1(4.8) 0(0.0) 3(14.3) 10(47.6) 7(33.3) 4.05 0.97 0.95
1
Having a good sex life is an important part of my life 2 2(9.5) 0(0.0) 1(4.8) 12(57.1) 6(28.6) 3.95 1.12 1.25
1
My sex life is boring* 2 7(33.3) 9(42.9) 2(9.5) 1(4.8) 2(9.5) 3.86 1.24 1.53
1
I know what kinds of sexual behaviors I like 2 1(4.8) 1(4.8) 2(9.5) 13(61.9) 4(19.0) 3.86 0.96 0.93
1
My sex life is exciting 2 2(9.5) 1(4.8) 4(19.0) 10(47.6) 4(19.0) 3.62 1.16 1.35
1
My sexuality is a positive force in my life 2 2(9.5) 1(4.8) 2(9.5) 13(61.9) 2(9.5) 3.60 1.10 1.20
0
My sexuality makes me feel good about my life 2 3(14.3) 1(4.8) 2(9.5) 13(61.9) 2(9.5) 3.48 1.21 1.46
1
Item n SD D U A SA Mean Std Variance
n(%) n(%) n(%) n(%) n(%) Dev
Component 9: Intimacy & Relationships
Overall, I feel close to my sexual partner 1 0(0.0) 1(4.8) 2(9.5) 7(33.3) 8(38.1) 4.22 0.88 0.77
8
I feel my sexual partner is sensitive to my needs and 1 0(0.0) 1(4.8) 2(9.5) 7(33.3) 7(33.3) 4.18 0.88 0.78
desires 7
I feel I can express what I like and don’t like sexually 2 0(0.0) 1(4.8) 1(4.8) 13(61.9) 6(28.6) 4.14 0.73 0.53
Parent-Adolescent Communication about Sex 133

1
Overall, I feel satisfied about my current sexual 1 0(0.0) 1(4.8) 3(14.3) 8(38.1) 7(33.3) 4.12 0.88 0.77
relationship 9
I have difficulty keeping a sexual partner* 2 9(42.9) 8(38.1) 2(9.5) 0(0.0) 2(9.5) 4.05 1.20 1.45
1
Talking about sex with my sexual partner is a satisfying 2 0(0.0) 2(9.5) 3(14.3) 8(38.1) 8(38.1) 4.05 0.97 0.95
experience 1
I feel my sexual partner avoids talking about sexuality 1 4(19.0) 10(47.6) 4(19.0) 0(0.0) 0(0.0) 4.00 0.69 0.47
with me* 8
When I have sex with my sexual partner, I feel 2 1(4.8) 1(4.8) 3(14.3) 11(52.4) 5(23.8) 3.86 1.01 1.03
emotionally close to him or her 1
I have difficulty finding a sexual partner* 2 6(28.6) 10(47.6) 2(9.5) 1(4.8) 2(9.5) 3.81 1.21 1.46
1
Some sexual matters are too upsetting to discuss with my 2 5(23.8) 8(38.1) 3(14.3) 3(14.3) 2(9.5) 3.52 1.29 1.66
partners* 1
Component 10: Spirituality & Values
I am a very spiritual person 2 0(0.0) 6(28.6) 0(0.0) 8(38.1) 7(33.3) 3.76 1.22 1.49
1
I have strong spiritual beliefs 2 1(4.8) 6(28.6) 1(4.8) 7(33.3) 6(28.6) 3.52 1.33 1.76
1
My spiritual beliefs affirm my sexuality 2 1(4.8) 7(33.3) 1(4.8) 6(28.6) 6(28.6) 3.43 1.36 1.86
1
I have strong religious beliefs 2 2(9.5) 6(28.6) 2(9.5) 4(19.0) 7(33.3) 3.38 1.47 2.15
1
My spirituality is very important for me in how I view my 2 1(4.8) 6(28.6) 4(19.0) 9(42.9) 1(4.8) 3.14 1.06 1.13
sexuality 1
I am a very religious person 2 2(9.5) 8(38.1) 4(19.0) 2(9.50 5(23.8) 3.00 1.38 1.90
1
I often attend religious services 2 2(9.5) 10(47.6) 1(4.8) 3(14.3) 5(23.8) 2.95 1.43 2.05
1
Sex is a sacred/holy act 2 2(9.5) 9(42.9) 4(19.0) 3(14.3) 3(14.3) 2.81 1.25 1.56
1

Item n SD D U A SA Mean Std Variance


Parent-Adolescent Communication about Sex 134

n(%) n(%) n(%) n(%) n(%) Dev


I am affirmed in my sexuality by my higher power 2 4(19.0) 6(28.6) 5(23.8) 4(19.0) 2(9.5) 2.71 1.27 1.61
1
Sexual behavior is an expression of God’s love in my life
2 4(19.0) 10(47.6) 4(19.0) 2(9.5) 1(4.8) 2.33 1.06 1.13
1
Sexuality helps me feel connected to God 2 6(28.6) 8(38.1) 6(28.6) 0(0.0) 1(4.8) 2.14 1.01 1.03
1
* Reverse coded items
Parent-Adolescent Communication about Sex 135

Appendix B

Pilot Study Descriptive Statistics for Individual Items in the Relationship Satisfaction Scale

Item n SD D U A SA Mean Std Variance


n(%) n(%) n(%) n(%) n(%) Dev
I was satisfied with the way my parents disciplined me 2 1(4.8) 3(14.3) 2(9.5) 10(47.6) 4(19.0) 3.65 1.14 1.29
0
I was satisfied with the love and affection my parents showed 2 1(4.8) 4(19.0) 1(4.8) 9(42.9) 5(23.8) 3.65 1.23 1.50
me 0
I was satisfied with the fun my parents and I had together 2 2(9.5) 3(14.3) 0(0.0) 11(52.4) 4(19.0) 3.60 1.27 1.62
0
I was satisfied with the relationship I had with my parents 2 2(9.5) 4(19.0) 0(0.0) 8(38.1) 6(28.6) 3.60 1.39 1.94
0
I was satisfied with the respect my parents showed me 2 2(9.5) 2(9.5) 3(14.3) 10(47.6) 3(14.3) 3.50 1.19 1.42
0
I was satisfied with the emotional support my parents 2 2(9.5) 4(19.0) 0(0.0) 10(47.6) 4(19.0) 3.50 1.32 1.74
provided me 0
I was satisfied with how many things my parents and I had in 2 1(4.8) 5(23.8) 0(0.0) 11(52.4) 3(14.3) 3.50 1.19 1.42
common 0
I was satisfied with the way my parents and I communicated 2 1(4.8) 5(23.8) 4(19.0) 6(28.6) 4(19.0) 3.35 1.23 1.50
with each other 0
I was satisfied with the household responsibilities my parents 2 1(4.8) 6(28.6) 2(9.5) 8(38.1) 3(14.3) 3.30 1.22 1.48
gave me 0
I was satisfied with the way my parents and I resolved our 2 2(9.5) 5(23.8) 4(19.0) 6(28.6) 3(14.3) 3.15 1.27 1.61
conflicts 0
I was satisfied with the amount of time my parents and I spent 2 1(4.8) 8(38.1) 2(9.5) 6(28.6) 3(14.3) 3.10 1.25 1.57
together 0