Adolescent sexual risk behavior: a multi-system perspective.

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

Adolescent sexual behavior in two ethnic minority groups: a multisystem perspective.

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, such as infection with HIV and other sexually transmitted diseases, as well as unintended pregnancy. In the present study, a multisystem model was applied to one adolescent sexual behavior, penile-vaginal intercourse. Nine hundred seven Black and Hispanic adolescents (aged 14 to 17 years) and their mothers were interviewed. Factors from three systems (self, family, and extrafamilial) that are influential in the lives of adolescents were evaluated using four outcome measures. Factors from most or all systems emerged as predictors of each outcome measure. A cumulative risk index suggested a linear relationship between the number of systems identified as being at risk and indicators of adolescent sexual behavior. The implications for prevention are discussed.

Family communication about sex: what are parents saying and are their adolescents listening?

CONTEXT: Communication between parents and adolescents about sex, particularly in minority families, has been understudied; more information is needed both on which sex-related topics are discussed and on how their content is transmitted. METHODS: Parent-adolescent communication about 10 sex-related topics was examined in a sample of 907 Hispanic and black 14-16-year-olds. Chi-square analyses were performed to test for significant differences across the 10 topics in discussions reported by the adolescents (with either parent) and by the mothers. The openness of communication, parent-adolescent agreement about communication of topics and differences by gender and ethnicity were also examined. RESULTS: Significantly higher proportions of mothers and adolescents reported discussions of HIV or AIDS (92% by mothers and 71% by adolescents, respectively) and STDs (85% and 70%, respectively) than of issues surrounding sexual behavior, contraceptive use and physical development (27-74% for these other eight topics as reported by mothers vs. 15-66% as reported by adolescents). The gender of the adolescent and of the parent holding the discussion, but not the family's ethnicity, significantly influenced findings, with adolescents of both sexes more likely to report discussions with mothers than with fathers, and with parents more likely to discuss any of the 10 topics with an adolescent of the same gender than of the opposite gender. The likelihood of a topic being discussed and of mother-adolescent agreement that a topic was discussed both increased with an increasing degree of openness in the communication process. CONCLUSIONS: Consistent with research among white samples, mothers of black and Hispanic adolescents are the primary parental communicators about sexual topics. To facilitate communication, educational programs for parents should cover not only what is discussed, but how the information is conveyed.

PIP: In the US, Black and Hispanic adolescents have an increased risk of a number of negative consequences of sexual activity, but most studies about parent-adolescent sex communication have been based on White samples, have failed to examine specific content of discussions, have considered the adolescent's perspective only, and have focused on whether (but not how) sexual information is transmitted. This analysis used data from interviews with 982 mother-adolescent pairs who took part in the 1993-94 Family Adolescent Risk Behavior and Communication Study. Sexual communication with either parent was measured by 10 questions to adolescents, sexual communication with adolescent was measured by rewording these questions for mothers, and another 10 questions measured the process of sexual communication. It was found that the topics of HIV/AIDS and sexually transmitted diseases were covered significantly more than other issues. Findings were influenced by the gender of the adolescent and the parent but not by ethnicity. Adolescents of both sexes were more likely to report discussions with mothers than with fathers, and parents were more likely to discuss the 10 topics with adolescents of the same gender. As openness in the communication process increased, so did the likelihood of a topic being discussed and of mother-adolescent agreement that the discussion took place. It was concluded that educational programs for parents should include the topic of how information is conveyed.

Cumulative risk across family stressors: short- and long-term effects for adolescents.

This study examined the relationship between number of family risk factors during adolescence and three areas of psychosocial adjustment (internalizing problems, externalizing problems, and academic achievement) in adolescence and 6 years later in young adulthood. Risk factors examined included parental divorce, interparental conflict, maternal physical health problems, maternal depressive mood, and mother-adolescent relationship difficulties. The findings indicated both concurrent and long-term associations between number of family risk factors and psychosocial adjustment; however, the results differed based on area of adjustment examined and whether concurrent or longitudinal data were considered. Furthermore, a steep increase in adjustment difficulties occurred when number of risk factors increased from three to four. The results are discussed in the framework of four hypotheses which were tested, and clinical implications are delineated.

The role of parental and extrafamilial social support in the psychosocial adjustment of children with a chronically ill father.

The relationships among illness stress, perceived support, and child psychosocial adjustment were examined for children living with a chronically ill father. Participants included fathers, mothers, and one child from 53 families in which the father had hemophilia and, in some cases, was HIV seropositive. Objective indicators of severity of illness and subjective measures of the physical and psychological impact of illness were used as sources of children's stress. Results indicated that the impact of illness, but not the severity of illness itself, related to child psychosocial adjustment. Main effects were observed for parental support on child- and parent-reported internalizing problems and stress-buffering effects were obtained for parental support and extrafamilial support on parent-reported internalizing problems. Parental support also demonstrated a stress-buffering effect for child-reported depression. Assessment and intervention implications for behavioral clinicians and researchers are discussed.

Family members' uncertainty about parental chronic illness: the relationship of hemophilia and HIV infection to child functioning.

Examined the relationships among parental and child uncertainty about fathers' illnesses and child internalizing problems. Participants included 65 families in which the father had hemophilia, approximately one half of the fathers also were HIV infected. Within each family, respondents included the father, the mother and one child. Outcome variables included both self- and parent-reported child internalizing behaviors. Results indicated that family members' illness uncertainty was intercorrelated, that child uncertainty about the father's illness predicted both anxiety and depressive symptoms in the child, and that mother's uncertainty predicted child-reported anxiety beyond the child's uncertainty.