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Sexual concerns have always featured in the psychological landscape of adolescence--at least in those cultures where there is an extended period between the onset of puberty and marriage. But sex has typically been carefully regulated by society. In earlier generations, sex was spoken of in whispers or not at all, and enacted infrequently before marriage. The past few decades have seen an astonishing shift in most Western countries in the openness with which sexuality has been portrayed and discussed. Today we are inescapably exposed to sexual messages--in news media, film, television, music and MTV, on the Internet, as well as in advertisements for all manner of goods. There are also changing mores about sex. Sex is no longer confined to marriage, and the diversity of sexual experience is more public both in terms of practices and sexual orientation.
The changing sexual mores are also reflected in changing societal messages concerning risk management of sexual activity. In the past, the prevailing message ("Don't have sex") reflected the high likelihood of costly outcomes such as loss of reputation or unwanted pregnancy. Today there is an added need to grapple with challenges to sexual health. As well as unacceptably high rates of unwanted pregnancy, there is vulnerability to HIV and other sexually transmitted infections (STIs). The potential for risks to young people's sexual health and the heavy costs to society have underscored the urgent need to provide greater guidance to responsible sexual decision making.
Societal guidance concerning sexual activity varies across different countries (and sometimes across differentstates within a country). In some places, such as the Netherlands, Scandinavia, and Australia, there is a wellentrenched and far-reaching policy of harm reduction in sex education programs available to young people. Programs based on this policy acknowledge the reality that young people are sexually active and are concerned with minimizing the harm that may result from this. The message is "If you have sex, have it safely," and the reference to safety is largely a matter of disease prevention. In other places (such as in the United States), many institutions, especially schools, promote sex education programs in which abstinence is regarded as the only appropriate message. The old message, now translated into "Just say no," remains the dominant one, despite clear evidence that teen sex is normative.
It is clear from over a decade of wide-ranging research that today's young people are sexually active at an earlier age than preceding generations were and that a majority become sexually active before high school graduation (Henshaw, 2001; Rosenthal, Smith, and Lindsay, 1999; Sonenstein, 2001; Wellings and others, 1995). However, the sexual activities of today's young people differ from those of earlier generations in ways other than age of sexual debut. For example, over the course of adolescence, young people today are likely to have multiple partners (Rossi, 1997), frequently in the course of short-term relationships or with partners that are not known well (Feldman, Turner, and Araujo, 1999). Sexual experimentation, including sexual intercourse, occurs earlier in the relationship and no longer necessarily carries with it a long-term commitment. Young people increasingly engage in a diversity of sexual behaviors including oral and anal sex. They are more likely than earlier generations of teens to use condoms (Sonenstein, 2001; Youth Risk Behavior Surveillance System, 2001), albeit not as consistently as they intend (Baele, Dusseldorp, and Maes, 2001). Moreover, in spite of health promotion programs that link condom use with prevention of HIV and other STIs, condoms are used primarily as contraception rather than for disease prevention and are therefore abandoned when other forms of contraception are used (Civic, 1999; Lindsay, Smith, and Rosenthal, 1999).
As a result of high rates of sexual activity during the teenage years, a sizable number of young people today are exposed to unwanted outcomes, including date violence and sexual abuse, unintended pregnancy and its consequences, and sexually transmitted infections. For example, many young women (and a small but notable minority of young men) report incidents of sexual abuse from mild coercion to rape (for example, see Abbey, Ross, McDuffie, and McAuslan, 1996; Gaertner and Foshee, 1999; Koss and Cook, 1998). Pregnancy rates, despite recent heartening declines (Henshaw, 2001), remain unacceptably high. Kirby (1997) reports that in the United States about 11 percent of girls aged fifteen through nineteen become pregnant each year with about three-quarters of these births occurring outside of marriage. Among sexually active girls, the pregnancy rate per year rises to more than 20 percent (Kauffmann and others, 1998). These figures are higher than in other countries such as the United Kingdom and Australia (where currently less than 3 percent and 2 percent of teens become pregnant each year, respectively). The negative consequences of teenage childbearing, for both mother and child, have been well documented (Coley and Chase-Lansdale, 1998). These include a higher fetal death rate and more hospitalizations for miscarriage or spontaneous abortion for teenage mothers than for mothers of all other ages.
Accurate data on planned terminations are difficult to obtain, but in one state in Australia in 1997, over half of adolescent pregnancies were terminated. In the United States, an estimated 40 percent of teen pregnancies end in abortion (Aquilino and Bragadottir, 2000), although these rates are declining (Kauffmann and others, 1998). We know that there are many psychological and social costs to teenage pregnancy as well. Mothers are less likely to remain in school and more likely to have large families and to be a single parent. The children have less supportive home environments and poorer health, behavioral, and educational outcomes, and the girls are more likely to become teenage mothers themselves (Coley and Chase-Lansdale, 1998; Maynard, 1996).
Infection with an STI is also a serious issue for young people. Kirby (1997) reports that roughly one in eight young people between thirteen and nineteen years (about one in four who have had sexual intercourse) acquire an STI every year in the United States. In Australia the figures are lower but the incidence of many STIs has been increasing in recent years, with the majority of cases reported among the youth population. The costs of these infections to the individual and to society can be grave. As well as the risk of HIV, other STIs can cause infertility or cancer and can increase vulnerability to HIV infection.
Sex-Related Guidance and Communication
The potential for risks to teenagers' sexual health and the heavy costs to society have underscored the urgent need to provide greater guidance to young people in their sexual decision making. But who should provide this guidance? One important avenue for reaching young people is through school-based sex education, which in many states and countries is now mandatory. However, school-based programs were envisaged as an adjunct to parental communication about sex and sexuality, rather than as a replacement.
There are many reasons why we might expect parents, as primary socializers of their children, to be involved in the sex education of their children. First, a fundamental task of parenthood is to transmit values to their children, and beliefs about sex and sexuality reflect religious and personal values of great importance to parents. Many parents assume, or at least hope, that talking to children about values will result in children's adopting those values and acting accordingly. For example, if parents believe in abstinence before marriage and convey this belief to their children, then it is expected that their children will not engage in premarital sex. We know, however, that parents are often misguided in their expectation that their children's sexual outcomes will be consistent with parental values.
Second, many parents assume that children's lack of information about the potential risks of adolescent sexuality contributes to their risky sexual practices. A corollary of this assumption is the belief that once teens are informed of the risks related to sexual activity they will make better sexual decisions and will be less likely to engage in risky sexual practices. Again, researchers have shown that this assumption is false and that providing information about sex-related issues does not necessarily change young people's sexual practices.
Conveying values and information to one's offspring has always been considered central to the role of parenting. What has changed in recent decades is how parents might achieve this goal. In the twenty-first century, the good parent is expected, among other things, to socialize children for adulthood, to nurture and to protect them from harm, to be available to them, and to engage in open communication. Good parents are also expected to be responsive to the viewpoints of their children, to listen and to learn as well as to teach (Quatman, 1997). This, together with the fact that sex is very much on the agenda in today's society, has led many parents to feel an obligation to discuss sexuality. Moreover, having been teenagers themselves during the sexually liberated decades of the 1970s and 1980s, parents of today's teenagers may find it harder to deny young people's involvement in sex.
However, a big step is required in translating perceived obligation into effective action. Many parents want to talk to their children about sex and sexuality but fail to do so (in anything other than the most cursory manner) because they don't have the skills or knowledge or the comfort level to do so. Among those who do talk to their children, some use a strategy of moral exhortation, laden with directives and prohibitions. Others use a sex education approach that is top-down, with information flowing from expert to novice. Yet others engage in communication which is mutual and bidirectional. The assumption has been that some of these family communication patterns are more effective than others in promoting sexual decision making that is consistent with healthy outcomes. This assumption needs to be scrutinized.
Overview of This Volume
The chapters in this issue begin this scrutiny by reviewing what we know about parent-teen communication about sexuality. In the first chapter, James Jaccard, Tonya Dodge, and Patricia Dittus provide a critical review of recent research in the field, including such topics as whether parent-adolescent communication influences adolescent sexual risk taking, what acts as barriers to effective sex-related communication, and what factors influence the type, amount, and quality of sex-related communication between teens and their parents. What is more important, however, they go beyond merely describing influences and outcomes, arguing that such an approach has limited utility. They provide a leap forward for the field by developing a conceptual framework to explain the dynamics of parent-adolescent communication about sexuality and the potential influence on young people's behaviors and attitudes. In a novel approach, they analyze the communication process and apply this analysis within a behavioral framework based on core constructs derived from key theorists in health-related fields. They then use this framework to clarify the ambiguities and contradictions that have been evident in research outcomes.
In the second chapter, Eva Lefkowitz discusses the difficult task of how we ensure that we obtain measures of communication that accurately reflect real-life interactions. This task, difficult at the best of times, is made more so when the sensitive topic of sexuality is the focus of measurement. Lefkowitz raises a number of critical issues that must be considered in designing research in this field. These include the need to go beyond yes-no responses to simple questions asked of one informant. Rather than simply relying solely on traditional self-report formats, Lefkowitz urges researchers to use innovative, multiple methodologies such as observations, diary studies, and Internet interactions to map communication between parents and adolescents.
The next two chapters, both based on empirical data, focus on so-called marginalized groups and use qualitative methodology. Maggie Kirkman, Doreen Rosenthal, and Shirley Feldman report on the role of fathers in the communication process. Although clearly fathers are not marginalized in the traditional sense, they are rarely the subject of research in sexuality. In this chapter, the researchers use the words of the participants to show that fathers experience considerable difficulty in discussing sexual matters with their adolescent children, difficulties that their own fathers, in turn, experienced. Yet generational changes are evident as we hear how many of the fathers in this sample were trying, sometimes with great difficulty, to juggle the demands of traditional masculinity with their desire to be good fathers who are available as communicators.
In the second empirical chapter, Lynne Hillier reports on an important, pathbreaking study that turns the communication process on its head. Research into communication about sexuality has taken for granted that it is parents who have information that young people need or should have. In this chapter, Hillier reports on a situation in which it is the young people themselves--in this case young people who are attracted to others of the same sex--who have important information about themselves and their sexuality that they wish to communicate to their parents. It is this process that Hillier eloquently documents. She takes us from the point at which the young person has to decide whether to take the risk of "coming out" to parents, including the reasoning that goes into this decision, and goes on to discuss how parents respond to this information. Given that studies show that a sizable minority of young people are not exclusively attracted to those of the opposite sex, this chapter is an important addition to the corpus of research on parent-adolescent communication about sexuality.
The final chapter, by Douglas Kirby and Brent Miller, addresses the question of whether we can provide parents with the knowledge and skills to be better communicators. This work builds on the assumption that parents can be taught appropriate communication skills that will overcome barriers that inhibit discussions about sex. Kirby and Miller evaluate intervention programs that use a variety of strategies for involving parents. They conclude that in spite of some success in improving parent-teen sex-related communication, the effects on teen sexual behavior are limited. They caution that many methodological problems limit their conclusions and make a plea for more rigorous evaluation.
S. Shirley Feldman
Doreen A. Rosenthal
S. SHIRLEY FELDMAN is senior research scientist, Division of Child Psychiatry and Behavior, and associate director, Program in Human Biology, at Stanford University, Stanford, California.
DOREEN A. ROSENTHAL is associate dean (research) in the Faculty of Health Sciences,