Parental intervention programmes could reduce risky sexual behaviour in adolescents
Involving parents in sexual health programmes may improve certain sexual behaviours in adolescents, according to a recent meta-analysis.
“[W]e found a significant positive association of parent-based sexual health interventions with condom use and parent-child communication about sexuality,” said the authors led by Assistant Professor Laura Widman from North Carolina State University, Raleigh, North Carolina, US.
The findings were based on a review and analysis of 31 randomized trials focusing on sexual health interventions or programmes (with parental involvement as a key intervention) for adolescents in the US (n=12,464, mean age 12.3 years). The duration of intervention ranged across the studies, from <3 hours to ≥20 hours, with the complete intended duration achieved in 10 studies.
The results showed that parent-based interventions improved condom use in adolescents (standardized mean difference [d], 0.32, 95 percent confidence interval [CI], 0.13–0.51; p=0.001). [JAMA Pediatr 2019;doi:10.1001/jamapediatrics.2019.2324]
There was significant heterogeneity between studies pertaining to this association. The intervention appeared to have a greater effect in younger (age <14 years) compared with older adolescents (d, 0.64; p<0.001 vs d, 0.15; p=0.10) and with longer duration of intervention (d, 0.41; p=0.02 [10–19 hours] and d, 0.44; p<0.001 [≥20 hours] vs d, -0.03; p=0.73 [3–9 hours]). The association was also stronger in studies focused on African-American and Hispanic adolescents (d, 0.29; p=0.07 and d, 0.54; p<0.001, respectively) than studies with mixed races/ethnicities (d, 0.09; p=0.51) and in studies that involved parents and adolescents equally (d, 0.58; p<0.001) than parent-only (d, 0.09; p=0.74), mostly parent (d, 0.07; p=0.50), and mostly adolescent studies (d, 0.12; p=0.39).
“These are variables that make sense intuitively: reaching kids when they’re younger and, often, more willing to listen; involving both parents and adolescents; spending more time on the subject matter – none of those are particularly surprising,” commented Widman. “However, it’s good to see that the data bears this out.”
As such, sex educators should bear in mind the greater potential for success if these interventions are introduced earlier and are culturally appropriate, the researchers added. Longer parent-child contact may also be required for positive results.
There was also an improvement in parent-child sexual communication with parent-based interventions (d, 0.27, 95 percent CI, 0.19–0.35; p=0.001), with no significant between-study heterogeneity.
However, parent-based interventions did not lead to a delay in initiating sexual activity (d, -0.06, 95 percent CI, -0.14 to 0.02; p=0.16), with no significant heterogeneity between studies. The programmes were also not associated with earlier sexual debut, said the researchers.
“In other words, the kids who were taught about sexual health did not become sexually active any earlier than kids who were not part of the interventions – but kids who were part of the interventions were more likely to use condoms when they did become sexually active,” said Widman.
Previous research evaluating the impact of parent-based sexual health interventions on adolescent sexual health has produced conflicting findings with some studies showing an association between parental involvement and delayed sexual activity and increased contraceptive use in adolescents, and others showing no effect. [Am J Public Health 2007;97:1084-1089; J Health Care Poor Underserved 2006;17:218-239; Health Educ Res 2011;26:808-833]
“This [study] highlights the value of parent-based interventions and makes clear that certain features are especially valuable when developing interventions,” said study co-author Reina Evans, a PhD student at North Carolina State University.
Avenues for future research include focusing on online interventions and father-focused interventions, tailoring interventions to sexual minority adolescents, and improving adherence to intervention programmes, the researchers said.
“[F]uture parent-based interventions should [also] draw on conceptual frameworks that link theories of parental influence and adolescent behaviour and account for contemporary social and societal factors shaping adolescent sexual and reproductive health,” added Professor Vincent Guilamo-Ramos from New York University, New York, US, and colleagues in an editorial. [JAMA Pediatr 2019;doi:10.1001/jamapediatrics.2019.2312]
“[E]valuation designs that provide empirical evidence for the active components of interventions with strong associations are important to improve theory, scalability, and efficiency,” they said.