All Chapters Combined Done

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
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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
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
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,
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.
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
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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.

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

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

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

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

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

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)

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

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
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.

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

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%
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
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)

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).
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

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”
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
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.

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
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,
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
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).

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
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
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
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
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
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
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).
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
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
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).

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

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

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
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
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

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
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
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
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

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).

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

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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
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
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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
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
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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,
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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
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
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

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

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,

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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).
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
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
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
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

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
about Sex 84
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).

about Sex 85
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
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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.
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
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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”
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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.
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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.
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).
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.
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
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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%
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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
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.
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
1
Total Sexual Health 1 104-520 399.4 20.83 433.77 208.0 232.0 440.00
3 6 0 0
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
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

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
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
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

(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.

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
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
necessary)
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
* SES will be determined by eligibility for free/reduced-price school lunch during

adolescence
Summary
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.

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APPENDIXES
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
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

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
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
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

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
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

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
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
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
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

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
Appendix B
Pilot Study Descriptive Statistics for Individual Items in the Relationship Satisfaction Scale

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

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The Relationship between Sexuality Based Parent-Adolescent Communication and

Overall Sexual Health among Selected University Students

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

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

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

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

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).

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

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

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

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

development; developing and maintaining healthy relationships; personal skills;

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

Kreinen (2001) stated that children need adults to:

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

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

their own (p. 3).

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

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

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

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

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

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

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

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

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

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

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

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

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

endorsing and promoting parents as sexuality educators without a complete

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

development through parental communication includes providing parents with the

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

Significance to Health Education

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

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

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

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

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

(Bockting et al., 2005).

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

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

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

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

myriad of potential problems, including further transmission due to asymptomatic

of sexual health. Understanding the correlation between parental communication and

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