Robert Wm. Blum, MD, MPH, PhD Center for Adolescent Health & Development WHO Collaborating Centre on Adolescent Heal

1. Teen Sexuality and the Role of Communication and Decision-Making Robert Wm. Blum, MD, MPH, PhD Center for Adolescent Health & Development WHO Collaborating Centre on Adolescent Health University of Minnesota Prepared for: 16th Annual UICMCH Leadership Conference April 28, 2003 Chicago, IL

2. While teen pregnancy has declined every year since 1991, it continues to be the highest in the industrialized world costing $6.9 billion annually.

3. What have we learned from a generation of adolescent pregnancy prevention programs?

4. Sex education increases short-term knowledge but has minimal effect on whether adolescents initiate sex or contracept.

5. Sexual education does not increase the likelihood of initiating sexual activity.

6. With very few exceptions programs focused on sex education or the provision of contraceptive services alone have little or not impact.

7. Family planning services reduce unwanted adolescent births through both contraception and abortion.

8. School-based clinics have not been shown consistently to reduce sexual activity or pregnancy.

9. Abstinence - only prevention programs have not been shown to reduce sexual activity.

10. Most interventions are not based on theory; when they are they appear to have more impact.

11. Most interventions have not been informed by research; and most do not evaluate what they do.

12. What do we know about the influence of parent-teen communications?

13. Parent/child connectedness (support, closeness, warmth) is associated with an older age of first intercourse and a lower frequency of sex during adolescence.

14. Parent attitudes and values disapproving of adolescent sexual intercourse (or unprotected intercourse) is associated with later age of sexual initiation.

15. The research is less clear as to the role of parental supervision/regulation. Some studies suggest it is associated with a delay in the onset of intercourse while other studies show that strict parenting is associated with a higher risk of early sexual initiation.

16. It is uncertain to what extent and how parent/teen communication about sex and contraception affects adolescent sexual behaviors.

17. Recent research from the National Longitudinal Study of Adolescent Health (Add Health).

18. Add Health In-School Sample (1994) 129 Schools (79%) 90,118 (75.6%) • Saturation • High income African American • Twins • Disability In-Home Samples (1995) N=15,243 Core In-school survey & school rosters Special Teen N=12,105 (79.5%) Parent N=10,471 (86.5%) Wave 1 (1994-5) Wave 2 (1996) Teen

19. Characteristics of Two Studies on Transition to First Intercourse

20. What Questions Does the Present Research Address? • Are teens aware of their mothers’ disapproval of their having sex? • Do mothers know whether their teens have had sex? • Do mothers talk to their teens about sex and birth control? What influence does it have?

21. What Questions Does the Present Research Address? • Mothers talk, teens’ perceptions: What matters? • What effect do closeness and connectedness have on teen sex? • What else about mother makes a difference for sexual initiation?

22. Are teens aware of their mothers’ disapproval of their having sex? *8th-11th grade weighted sample (unpublished data)

23. Do mothers know whether theirteens have had sex?

24. Do mothers talk to their teens about sex and birth control?

25. Do mothers talk to their teens about sex and birth control?

26. Do mothers talk to their teens about sex and birth control?

27. Do mothers talk to their teens about sex and birth control?

28. Mothers Talk, Teen Perceptions: What Matters? • It is what teens believe their parents believe that makes a difference; • Teen perceptions are influenced by what parents say but by so much more.

29. What effect does closeness and connectedness have on teen sex? Younger teens and older boys who feel connected to their mothers are less likely to have early sex.

30. Implications When it comes to delaying the initiation of sexual intercourse, caring and connectedness are important — especially for younger teens.

31. Implications Simply stating parents’ disapproval of teen sex is not enough. Clearly, some teenagers do not get the message. When they do get the message, teens are more likely to delay sexual intercourse.

32. Implications While so much is made these days over what we should say to our kids about sex, other aspects of parenting may have a greater influence.

33. Implications About 50% of parents seem to be unaware that their sons and daughters have started to have sex.

34. Implications Mothers may be more oriented to influencing their daughters’ sexual behavior and more oriented to influencing their sons’ risk of infection and early parenting.

35. Implications There are no simple answers for parents when it comes to talking to kids about birth control.

36. Implications To the extent that our messages, values and behaviors as parents are more consistent, teens may be able to comprehend both what we believe and what we say.