Talking about sex to teenagers

Jul 10 2008

Sex is one of the most difficult topics a parent can bring up with an adolescent, but a new study finds that parents who are taught specific communication skills can more readily tackle these conversations and sustain them over time.

The study, published online by the British Medical Journal on July 11 with an accompanying editorial, evaluated a parenting program called Talking Parents, Healthy Teens. The worksite-based program teaches parents how to get past their own inhibitions and fears of making a mistake, and how to maneuver around classic teenage shrugs and "uh huh" responses. Targeting parents of sixth to tenth graders, it is the first program of its kind to be rigorously developed and evaluated.

A research team led by Mark A. Schuster, MD, PhD, chief of general pediatrics and vice chair for health policy research at Children's Hospital Boston, randomized 569 parents, employed at 13 large public and private worksites in southern California, to participate in the program or to serve in a control group. (Schuster led the study while at RAND Corporation, where the program was developed and where he was Director of Health Promotion and Disease Prevention until moving to Children's in November 2007.)

Parents randomized to the program attended eight weekly lunch-hour sessions, in groups of about 15. Through role-playing and other interactive exercises, they learned techniques for starting and sustaining conversations on sensitive sex-related topics, including recognizing teaching opportunities in everyday situations, using creative opening lines, and identifying their teenage children's conversational roadblocks. Through the approach of "active listening," parents were taught to listen to their children without interrupting or starting to lecture. They also learned how to teach their children decision-making skills, assertiveness skills, and to have confidence in interacting with peers.

Between weekly meetings, parents practiced at home, playing games (designed by the program) with their children or discussing a variety of sex-related topics, including contraception, sexually transmitted diseases, and the consequences of pregnancy. The program acknowledged and supported parents' diverse views on sex-for instance, a single session covered both abstinence and condom use.

"The great thing was that the parents really learned," says Schuster, who is also on the faculty of Harvard Medical School and co-author of the book Everything You Never Wanted Your Kids to Know About Sex (But Were Afraid They'd Ask) (Three Rivers Press, 2004). "We'd teach them some skills one week, and they'd come back the next week bubbling over with excitement that they'd talked with their teen about relationships, love, or sex, and-this was the best part-their teen had actually engaged in a real conversation with them, or role-played a topic like how to say no to unwanted sexual advances."

Follow-up surveys conducted one week, three months, and nine months after the program documented significant and immediate effects. Parents in the intervention group reported more conversations about sexual topics that they had never discussed before, and more repeated conversations about previously discussed topics. They were also better able to discuss sexual matters openly with their children.

And their children, who were also surveyed, concurred. For example, according to the adolescents' reports, one week after program completion, 18 percent of parents receiving the intervention had reviewed the steps of using a condom, compared to 3 percent of the control group. By the nine-month mark, this difference had actually widened to 25 vs. 5 percent, indicating that the program had an ongoing influence on parents' behavior. Such a persistent effect is highly unusual for any parenting program, says Schuster.

Schuster and colleagues targeted the workplace to draw more parents to the program, knowing that employed parents often don't have time to regularly attend night or weekend sessions.

"Many employers provide programs to help employees lose weight or stop smoking," Schuster explains. "We wanted to see if we could apply worksite health promotion principles to help parents address their kids' sexual health. It turned out that employers loved the idea. They are under pressure to create family-friendly workplaces. And they're often providing the health insurance for these kids, so they are concerned about lost productivity when parents are distracted with their kids' sexual health issues."

Parents were equally grateful. "Parents are desperate for advice on how to talk with their kids about sex," Schuster says. "I get pulled aside in the clinic, at schools, at the park. They know it's important, but their own parents didn't talk with them, so they don't know where to begin. Even other physicians sheepishly ask what to say to their own kids."

http://www.childrenshospital.org