American Journal of Sexuality Education, 8:117, 2013

Copyright Taylor & Francis Group, LLC

ISSN: 1554-6128 print / 1554-6136 online
DOI: 10.1080/15546128.2013.790219

Teens Talking with Their Partners about Sex:

The Role of Parent Communication
MEREDITH SCHONFELD HICKS, MPH
University of Minnesota Healthy Youth Development, Prevention Research Center,
Minneapolis, MN, USA

ANNIE-LAURIE McREE, DrPH

University of Minnesota Department of Pediatrics, Division of General Pediatrics and
Adolescent Health, Minneapolis, MN, USA

MARLA E. EISENBERG, ScD, MPH

University of Minnesota School of Public Health, and Healthy Youth Development Prevention
Research Center, Minneapolis, MN, USA

This study examined the relationship between teens communication with their parents and their communication with their sexual
partners about risk prevention using data from a statewide sample of high school students (n = 24,781). We assessed associations
between parent-teen communication and teen-partner sexual risk
discussions using multivariable logistic regression. Teens with high
levels of general communication with their mothers or fathers had
greater odds of talking with partners about pregnancy and STI
prevention (p < .05), even controlling for parent-teen communication about sexuality. Study findings suggest that sexuality education programs should promote and build skills for parent-teen
communication about both general and sex-specific topics.
KEYWORDS Sexual health promotion, adolescents, sexual communication, adolescent sexuality

Hicks and Eisenbergs time on this project was supported in part through funds from the
Leadership Education in Adolescent Health (LEAH) Fellowship Training Program, University of
Minnesota (grant T71-MC-00006, Maternal and Child Health Bureau, HRSA, DHHS). McRees
time was supported by National Research Service Award (NRSA) in Primary Medical Care,
grant no. T32HP22239 (PI: Borowsky), Bureau of Health Professions, Health Resources and
Services Administration, Department of Health and Human Services.
Address correspondence to Meredith Schonfeld Hicks, ScD, MPH, University of Minnesota
Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 717 Delaware
Street SE, 3rd floor, Minneapolis, MN 55414. E-mail: eisen012@umn.edu
1

M. Schonfeld Hicks et al.

INTRODUCTION
Adolescence is a time of exploration and change. For many teens this means
they become sexually active. In 2009, 46% of U.S. high school students had
ever had sexual intercourse (Centers for Disease Control and Prevention,
2010). While engaging in sexual behavior is natural and can be healthy,
inconsistent condom and other contraceptive use among teens often leads to
high rates of sexually transmitted infections (STIs) and unintended pregnancy
(Holcombe, Carrier, Manlove, & Ryan, 2008) which, in turn, are associated
with an array of adverse social and health outcomes. For example, STIs
may result in stigma, infertility, and cancer (Chaturvedi, 2010; Cunningham,
Kerrigan, Jennings, & Ellen, 2009; Haggerty et al., 2010); early childbearing is
associated with lower educational attainment for teen parents and increased
poverty for their families (Maynard & Hoffman, 2008). In the United States,
nearly half of new STIs are in young people between the ages of 15 and 24
(Weinstock, Berman, & Cates, 2000) and nearly 400,000 girls age 1519 gave
birth in 2009 alone (Hamilton & Ventura, 2012).
Communication between sexually active teenagers and their partners
about sexual risk prevention is a protective factor for many health behaviors
and outcomes. For example, teen-partner communication about sexual risk
is associated with more frequent and consistent condom use (Crosby et al.,
2002; Whitaker, Miller, May, & Levin, 1999) and contraceptive use at first
intercourse (Stone & Ingham, 2002). These conversations can be challenging
but potentially life changing. An adolescents ability and agency to negotiate
condom use and/or birth control use is a critical skill for pregnancy and STI
prevention.
Despite the health benefits of conversations with sexual partners about
risk prevention, only about half of youth in grades 7 through 12 report
discussing STIs and contraception before sexual debut (Ryan, Franzetta,
Manlove, & Holcombe, 2007). Research suggests that even fewer young
women age 1726 discuss sexual risk topics with their current or most recent partner (Hutchinson, 1998). Several factors may prevent this communication from happening. For example, young people may perceive their
partner as low or no risk, be too uncomfortable or embarrassed, regard
such questions as too intimate, or not think about it in time (Hutchinson,
1998). Teenagers may also lack communication role models, such as parents,
who can help them build the skills to have these conversations. Parents or
other role models can provide an opportunity for teens to practice having
sensitive conversations on a variety of topics with people they care about.
A large body of literature supports the importance of parent-teen relationships on adolescent health outcomes (DeVore & Ginsburg, 2005;
Resnick et al., 1997). Parent-child connectedness, characterized as quality
of the emotional bond between parent and child, (Lezin, Rolleri, Bean, &
Taylor, 2004) can help young people navigate the risks and challenges of

Parent-Teen Communication

adolescence in many realms, including sexuality (Markham, Lormand, &

Gloppen, 2010). Previous research has identified many components of
parent-child connectedness, including warmth and caring, autonomy granting, parental monitoring, and parent-child communication (Lezin et al.).
Teens look to their parents as a trusted source of sexual health information (Hutchinson, 1998) and for core values about sexuality (Jaccard,
Dodge, & Dittus, 2002). Parent-teen discussions about sexuality and sexual
risk are associated with an increased likelihood of health promoting behaviors such as teen-partner discussion about sexual risk and teen condom use
(Whitaker et al., 1999). Among younger teens, sexual health information from
parents reduces the risk of having multiple partners and pregnancy involvement (Eisenberg, Sieving, Bearinger, Swain, & Resnick, 2006). The quality of
parent-teen communication matters; some research suggests that these protective effects occur only if the parents are perceived as being open, skilled,
and comfortable in having discussions about sexuality (Whitaker et al., 1999).
There is some evidence that parent-teen conversations about sexuality
may be happening less often than they used to. For example, Robert and
Sonenstein found that the percent of adolescent females who reported having
discussions with their parent about sexual risk dropped from 58% in 1995
to 44% in 2002. Even fewer adolescent males, only 32%, reported discussing
birth control with their parents in 2002 (Robert & Sonenstein, 2010).
Several factors influence these parent-teen conversations about sexuality, but one of the most consistent correlates is gender. Mothers do most of
the communication with their children about sexuality, and they talk to their
daughters more often than their sons. Compared to fathers, mothers experience fewer barriers (e.g., lack of sexual health knowledge and difficulty
finding time to talk) and more facilitators (e.g., shared activities with child,
closeness to child) to communication, and they have more positive expectations of the outcomes of talking with their child (Wilson & Koo, 2010).
Although parent-teen communication is important, many parents are
afraid or feel unprepared to talk with their teens about sexuality. Even without specifically discussing sexuality, parents can influence their teens communication behavior. The role of everyday parent-teen communication is
less researched, but there is some evidence that greater communication with
parents about everyday life results in higher odds of teens talking with their
partners about STIs or contraception before sexual debut (Ryan et al., 2007).
Additionally, greater parent-teen relationship quality was associated with
reduced sexual risk taking among adolescents (Deptula, Henry, & Schoeny,
2010). While not the same construct as parent-teen communication, these two
may go hand in hand as relationship quality, a component of parent-child
connectedness, may influence the frequency and quality of communication.
In the present study, we used a large, statewide sample to examine the
relationship between adolescents communication with their sexual partners
about sexual risk prevention, and their communication with their parents.

M. Schonfeld Hicks et al.

Specifically, we explored associations between teens general communication with their parents and their communication with their partners about
STI and pregnancy prevention, controlling for teens conversations with their
parents about sexuality. Based on the previous literature, we expected that
students who named their parents as a main source of information about
sex would be more likely to discuss pregnancy and STI prevention with
their sexual partners. We also hypothesized that students with high levels
of general communication with at least one of their parents would be more
likely to talk with every partner about prevention.
The current research expands on previous work in a number of ways.
First, we use a measure of communication with any sexual partner(s) in the
past 12 months. Previous research has largely focused on either adolescents
first or most recent partners, yet the risks of sexual activity are present in
every sexual encounter, not just the first, or most recent. The current study
explores communication consistency across multiple partners, which is critical for longer-term prevention. Second, the current study also explores teenpartner communication about STI prevention and pregnancy prevention separately; illuminating key differences that can inform interventions by furthering our understanding of factors that may promote specific prevention conversations. Finally, our study uses measures of both general parent-teen communication and parent-teen communication about sexuality. Using these two
distinct measures is important for understanding the role that general communication plays above and beyond communication specifically about sexuality.

METHODS
Study Design
This study utilizes data from the 2010 Minnesota Student Survey (MSS). The
MSS is a comprehensive, anonymous, in-school survey administered every
three years to students in 6th, 9th, and 12th grades throughout Minnesota
to monitor risk and protective health behaviors. Passive parental consent
was obtained by most school districts, but a few used an active consent
process. Student participation was voluntary and not every student who
participated answered every question. The MSS is a 127-item instrument
drawing from established measures in the literature. It is used extensively
in surveillance research with adolescents and has high face validity (Rock,
Ireland, & Resnick, 2003; Secor-Turner, Sieving, Eisenberg, & Skay, 2011).
The MSS assesses multiple areas including school and family characteristics
and relationships, communication with mother and father, sexual behaviors
and communication with sexual partners, school, teacher and community
connectedness, and other health-related behaviors. In 2010, 88% of all public
operating school districts in Minnesota agreed to participate and overall
participation across grades 6, 9, and 12 was approximately 71% of total

Parent-Teen Communication

enrollment (Anfinson & Kinney, 2010). The Institutional Review Board at the
University of Minnesota deemed this secondary analysis of MSS data exempt
from review.

Sample
The study goal was to identify factors associated with adolescent sexual
risk discussion with their partners. As such, only sexually active students
were included in the analysis. The inclusion criteria were based on student
self-report of ever having sexual intercourse or sex. This excluded sixth
graders (n = 46,787), as the sexual activity survey items were only asked of
students in grades 9 and 12 (n = 84,121), and nonsexually active students
(n = 49,213). Finally, students with missing information on key outcome
variables were excluded from the analysis (n = 10,127). The final analytic
sample for this study included 24,781 students. The students ranged in age
from 13 to 19 years old.

Measures
OUTCOME VARIABLES
The outcome variable for this analysis was communication with partner(s)
about sexual risk, which we assessed using two items: Have you talked with
your partner(s) about protecting yourselves from getting sexually transmitted
diseases/HIV/AIDS? and Have you talked with your partner(s) about preventing pregnancy? As pregnancy and STIs are common among adolescent
populations, we compared the recommended behavior (Kirby, 2007) of partner communication at least once with every partner with the risky behavior
of never communicating with their partner(s). To achieve this dichotomous
variable, we excluded respondents who chose the middle response option of
not with every partner for STIs (males: 16%; females: 15%) and pregnancy
(males: 16%; females: 14%).
INDEPENDENT VARIABLES
The key independent variable, general parent-teen communication, was derived from two parallel items about the students ability to discuss problems
with their father and mother. The items include: Can you talk to your a)
father b) mother about problems you are having? We created three separate
categories for each variable as follows: we categorized respondents as having a high level of communication if they indicated Yes, most of the time
or Yes, some of the time, a low level of communication if they indicated
No, not very often or No, not at all, and a third category if they indicated
their parent was not around. This approach allowed us to explore the role
of communication with each parent regardless of family structure.

M. Schonfeld Hicks et al.

Participants also indicated whether their parent was a source of information about sex through the item Where have you received most of
your information about sex? Students could mark all that apply from a
list of nine items. Response options included friends/peers, parents, brothers or sisters, clinics/doctors/nurses, religious/community groups, Internet,
TV/radio/magazines/newspapers/books and I do not know much about sex.
If the student marked parents as a response, they were considered to have
communicated with their parent(s) about sex.
The MSS assessed a number of protective factors including school connectedness and future education plans. When teens feel connected to their
schools and have plans for the future they are less likely to engage in sexual risk taking (Kirby, 2007). School connectedness is a scale involving four
survey items: How do you feel about going to school? How many of your
teachers are interested in you as a person? How many of your teachers
show respect for the students? and How much do you feel teachers/other
adults at school care about you? Each item had five response options (range
15). We reverse coded three items so they were all in a uniform direction with higher values indicating higher school connectedness (Cronbachs
alpha = .74). Future education plan was based on response to the item:
Which of these best describes your school plans? We dichotomized five
response options so that students who indicated that after high school they
would like to go on to some kind of trade or vocational school, college, or
college and graduate or professional school were categorized as having a
future education plan. Students who indicated that they would like to quit
school as soon as possible or finish high school but not attend college were
categorized as not having a future educational plan.
Additionally, we assessed the risk factor of number of sex partners.
Adolescents who have more than one sexual partner are at greater risk of
contracting an STI (Kirby, 2007). Multiple sex partners was defined as having
two or more sex partners (compared with one partner) within the previous
year based on student self-report. Adjusting for this variable allowed us to
see the role of parent communication regardless of the number of partners
a teen had.
The survey also assessed demographic information. Respondents described their race/ethnicity by marking all that apply to a list of seven options we categorized as: American Indian, Black/African American, Hispanic,
Asian American or Pacific Islander, non-Hispanic White, and Other (selected
two or more categories or I dont know). Students indicated whether they
currently get free or reduced-price lunch at school.

Analysis
We assessed the relationship between teens general communication with
their parents and teens communication with partners about sexual risk
prevention using logistic regression. We modeled communication about

Parent-Teen Communication

preventing STIs and communication about preventing pregnancy separately

and included both mother and father communication in each model. Models adjusted for source of information about sex, protective factors (school
connectedness, future education plan), risk factor (multiple sex partners),
and sociodemographic characteristics (race/ethnicity, free or reduced-price
lunch, grade), all of which have been found to be associated with teenpartner communication in other research (Kirby, 2002; Ryan et al., 2007).
We tested for interactions between mother and father communication and
adolescents gender and grade level. Only interactions between mother communication and gender were statistically significant; as a result, we stratified
analyses by gender. All analyses were conducted using SAS version 9.1 (SAS
Institute Inc., Cary, N.C.).

RESULTS
Sample Description
As noted in Table 1, males and females were almost equally represented
in the study sample. About three quarters (74%) of the sample identified
as non-Hispanic white and almost one-third (30%) received free or reduced
price lunch. Two-thirds (67%) were in 12th grade.
Overall, most adolescents reported always discussing STI and pregnancy
prevention with their sexual partners, although the likelihood of sexual risk
discussions with every partner differed by both gender and topic. Although
adolescents were less likely to discuss STI prevention with every partner
than pregnancy prevention, females were more likely to discuss these topics
with every partner than males (52% for STIs and 65% for pregnancy among
females vs. 43% and 53% among males, respectively). Additional details of
the sample are available in Table 1.
Most adolescents had a high level of communication with their mother
(males: 72%; females: 76%). Slightly fewer had a high level of communication
with their father (males: 65%; females: 53%). Less than half of teens reported
their parents as a source of information about sex (males: 38%; females: 45%).

Associations Between Parent Communication and Teen-Partner

Communication
Table 2 presents findings from multivariable logistic regression models examining the association between teens communication with parents and their
communication with sexual partners about risk prevention.

MALES
Among males, those with high levels of general communication with their
mothers had greater odds of talking with their sexual partners about both STI

M. Schonfeld Hicks et al.

TABLE 1 Sample characteristics, by gender (analytic sample n = 24,781)

Males
(n = 12,496)

Demographics
Race/Ethnicity
Non-Hispanic White
Asian
Black
Hispanic
Native American
Mixed/Other
Free or Reduced Lunch
Yes
No
Grade
9
12
Teen-Partner Communication
STI
Never
Not with every partner
At least once with every partner
Pregnancy
Never
Not with every partner
At least once with every partner
Parent-Teen Communication
General communication with mother
Low
High
Not around
General communication with father
Low
High
Not around
Parent source of sex information
No
Yes
Protective Factors
School Connectedness: mean (sd)
Future Education Plan
Risk Factor
Multiple Sex Partners

Females
(n = 12,285)

(%)

(%)

8965
398
806
650
243
1332

(72.3)
(3.2)
(6.5)
(5.2)
(2.0)
(10.7)

9157
487
572
555
172
1297

(74.8)
(4.0)
(4.7)
(4.5)
(1.4)
(10.6)

3484
8852

(28.2)
(71.8)

3691
8485

(30.3)
(69.7)

4365
8131

(34.9)
(65.1)

3762
8523

(30.6)
(69.4)

5080
1915
5317

(41.3)
(15.5)
(43.2)

3875
1907
6362

(31.9)
(15.7)
(52.4)

3969
1817
6588

(32.3)
(14.9)
(53.6)

2488
1722
7838

(20.5)
(14.0)
(64.6)

2641
9130
493

(21.5)
(71.5)
(4.00)

2541
9210
391

(20.9)
(75.8)
(3.20)

2903
8025
1419

(23.5)
(65.0)
(11.5)

4117
6419
1636

(33.8)
(52.8)
(13.4)

7556
4631

(62.0)
(38.0)

6659
5515

(54.7)
(45.3)

3.2
10833

(0.87)
(88.3)

3.3
11526

(0.78)
(95.5)

3974

(33.3)

2742

(22.7)

prevention (OR = 1.2, 95% CI: 1.1, 1.3) and pregnancy prevention (OR = 1.2,
95% CI: 1.1,1.4) than those with low parent communication, even controlling
for other factors related to teen-partner sexual risk communication (Table 2).
Findings for communication with fathers showed a similar pattern. Findings
for males with parents who were not around were equivalent to those with
parents in the low communication group.

Parent-Teen Communication
TABLE 2 Odds of partner communication about sexual risk stratified by gender
Males (n = 12,496, 50.4%)
STI

Females_(n = 12,285, 49.6%)

Pregnancy

STI

Pregnancy

OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)

Parent Communication
General communication with mother
Low (ref)

High
1.2 (1.1, 1.3)
Not around
1.0 (0.8, 1.3)
General communication with father
Low (ref)

High
1.2 (1.1, 1.3)
Not around
1.1 (1.0, 1.3)
Parent source of sex information
No (ref)

Yes
2.1 (1.9, 2.3)
Protective Factors
School Connectedness
1.2 (1.2, 1.3)
Future Education Plan
1.5 (1.3, 1.7)
Risk Factors
Multiple Sex Partners
0.8 (0.8, 0.9)
Demographics
Race/Ethnicity
Non-Hispanic White (ref)

Asian
0.9 (0.7, 1.1)
Black
1.5 (1.2, 1.8)
Hispanic
1.3 (1.1, 1.6)
Native American
1.2 (0.9, 1.7)
Mixed/Other
1.1 (0.9, 1.2)
Free or Reduced Lunch
Yes
0.9 (0.8, 1.0)
No (ref)

Grade
9 (ref)

12
1.1 (1.0, 1.1)

1.2 (1.1, 1.4) 1.4 (1.2, 1.5) 1.5 (1.3, 1.7)

1.0 (0.8, 1.2) 1.1 (0.9, 1.4) 1.1 (0.8, 1.4)

1.2 (1.1, 1.4) 1.2 (1.1, 1.4) 1.2 (1.1, 1.4)

1.1 (0.9, 1.3) 1.0 (0.9, 1.2) 1.1 (1.0, 1.3)

2.1 (1.9, 2.3) 2.4 (2.2, 2.6) 2.1 (1.8, 2.3)

1.2 (1.1, 1.3) 1.1 (1.1, 1.2) 1.1 (1.1, 1.2)
1.7 (1.5, 2.0) 1.4 (1.2, 1.7) 1.7 (1.4, 2.1)
0.6 (0.6, 0.7) 0.8 (0.7, 0.9) 0.7 (0.6, 0.8)

0.6
1.0
1.0
0.9
1.0

(0.5, 0.8)
(0.8, 1.2)
(0.8, 1.2)
(0.6, 1.2)
(0.8, 1.1)

0.9
1.3
1.0
1.0
1.1

(0.7, 1.1)
(1.0, 1.6)
(0.8, 1.3)
(0.7, 1.5)
(1.0, 1.3)

0.7
0.8
0.8
0.5
1.0

(0.5, 0.8)
(0.6, 1.0)
(0.6, 1.0)
(0.3, 0.7)
(0.9, 1.2)

0.9 (0.8, 1.0) 0.9 (0.8, 1.0) 1.1 (1.0, 1.2)

1.2 (1.1, 1.2) 1.1 (1.1, 1.8) 1.3 (1.2, 1.3)

Additionally, males who reported that their parents were a main source
of information about sex had greater odds of communicating with their sexual partners about STI prevention (OR = 2.1 95% CI: 1.9, 2.3) and pregnancy
prevention (OR = 2.1 95% CI: 1.9, 2.3) than those who did not indicate
parents as a source of information about sex.
Males also had significantly higher odds of communicating with
their partners if they had higher levels of school connectedness, a future education plan, and were in the 12th grade. They had significantly
lower odds of communicating with their partners if they had multiple
sex partners. Associations by race/ethnicity category were also statistically
significant.

10

M. Schonfeld Hicks et al.

FEMALES
Females with high levels of general communication with their mothers had
greater odds of always communicating with their partners about STI prevention (OR = 1.4, 95% CI: 1.2, 1.5) and pregnancy prevention (OR = 1.5,
95% CI: 1.3, 1.7) than those with low parent communication. Communication
with fathers showed a similar pattern, though the magnitude was larger for
mother-daughter communication (Table 2). Findings for females with parents who were not around were equivalent to those with parents in the
low communication group. Females who reported their parents as a source
of information about sex had greater odds of discussing STI prevention
(OR = 2.4, 95% CI: 2.2, 2.6) and pregnancy prevention (OR = 2.1, 95% CI:
1.8, 2.3) with their partners.
Additionally, females had significantly higher odds of communicating
with their partners about each topic if they: had higher levels of school
connectedness, had a future education plan and were in 12th grade. Additionally, having multiple sex partners was significantly associated with lower
odds of sexual risk discussion. Partner communication differed significantly
by several demographic characteristics including race/ethnicity and free or
reduced-price lunch.

DISCUSSION
Teens disproportionately experience STIs and pregnancy, which can dramatically alter their life course and opportunities. Engaging in protective health
behaviors, such as communication with their sexual partners about risk
prevention, is one way to reduce these consequences and promote healthier
behaviors. Increasing our knowledge about the role of parent-teen communication and teen-partner sexual risk discussion can inform interventions to
help teens be healthier. Our findings not only underscore the importance
of parent-teen communication about sexual health, but also demonstrate
that teens general communication with parents matters above and beyond
sexuality-specific conversations. This study makes additional contributions to
the literature by examining communication about STI prevention and pregnancy prevention separately, examining both general parent-teen communication and parent-teen communication about sexuality, and by including
teen communication with all sexual partners, not only the first or most recent.
Similar to other research (Ryan et al., 2007), we found that female teens
in this statewide sample communicated with their partners about prevention
topics more than male teens. We also found that teens communicated with
their partners about sexual risk prevention at rates similar to other studies (Stone & Ingham, 2002; Whitaker et al., 1999). Additionally, we found
that parent-teen communication, both generally and about sexual health,
is associated with greater odds of teen-partner sexual risk discussion. As

Parent-Teen Communication

11

anticipated, a higher level of parent-teen communication is significantly associated with greater odds of teen-partner communication about STI prevention and pregnancy prevention.
Although teens had significantly greater odds of sexual risk discussion
with their partners if they listed their parents as a main source of information
about sex, we found that fewer than half of the young people in our study
had communicated with their parents about sexuality. The proportion for
females in our study who communicated with their parents about sexuality is
lower than other recent research on adolescent girls (Stidham-Hall, Moreau,
& Trussell, 2012). Many teens desire these conversations and can name at
least one sexual health topic they want more information about from their
mothers and fathers (Hutchinson, 1998). This finding adds further support for
parents to specifically discuss sexual health with their teen and encourages
the use of effective programs to build parent communication skills (Akers,
Holland, & Bost, 2011; Kirby, 2008).
Above and beyond communication about sexuality, good communication with a parent can make a difference for a teenager (Ryan et al., 2007).
Families are composed in many ways and our findings suggest that a high
level of general communication with one parent, regardless of that parents
gender, can have a positive impact on teen protective behaviors. This means
that adolescents can experience the protective effect of parent-teen communication even if one parent is not around or if they have a low level
of communication with one parent. Further, the positive association with
general communication, even controlling for sexuality-specific discussions,
suggests that promoting parent-teen communication about general topics
can be an important prevention strategy that is likely to be acceptable to all
parents, including those who may not feel comfortable addressing sexuality
topics directly.
However, the difference in the magnitude of association between general parent-teen communication and parent as a source of information about
sex suggests that the content of the conversations is an important factor in
whether or not teens talk with their partners about sexual risk prevention.
While this study did not allow us to understand the content or quality of the
communication between parent and teen, this is an important consideration
for interventions. Promoting not only specific conversations about sexual
health but also open communication with teens could have added benefits.
While these associations are small, taken at a population level they
could have a substantial impact and increase the number of adolescents who
are communicating with their sexual partners about risk prevention (Rose,
1992). To achieve this population change, we need to shift the behavioral
norms around sexual risk communication. It takes two people to have sexual
intercourse, and if at least one of them can initiate a conversation about
prevention the other will likely participate as well, potentially decreasing
sexual risk for both partners.

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M. Schonfeld Hicks et al.

It is inherently more difficult for teens to communicate with every

partner if they have more than one partner. However, it is critical that they
do so because having multiple partners at a young age can be a risk factor
for pregnancy and STIs. It was important to adjust for multiple partners to
understand the role of parent communication for all sexually active teens,
regardless of the number of partners. These findings show that good parentteen communication in general and about sexuality-specific topics matters
for all teens, regardless of the number of sexual partners.
Race and ethnicity had varying significant associations with sexual risk
discussion. This may be related to specific cultural messages, communication
styles, and family values and norms. Additionally, STI rates are disproportionately high among adolescents of color in Minnesota (TeenwiseMinnesota,
2011). This may lead to greater awareness of STI prevention through targeted outreach campaigns for these groups of young people. The findings
in this study related to race and ethnicity were varied and inconclusive.
Sexual health programs must continue to stress the importance of pregnancy and STI prevention for all young people, regardless of race or
ethnicity.
Many young people perceive their sexual partners to be at low or no
risk for STIs (Hutchinson, 1998). This may contribute to the lower rates of STI
prevention discussion among teens in this study. We need to communicate
the importance of discussing both pregnancy prevention and STI prevention
with their partners. Understanding the potential health outcomes may encourage teens to use a dual method, hormonal birth control and a condom,
which would decrease their risk of contracting an STI.

Implications for Sexuality Educators

Our findings point to missed opportunities to promote adolescent sexual
health. Although many teens in our sample reported engaging their partners
in sexual risk prevention conversations, many teens are not having these
important conversations. One in four sexually active teens reported never
discussing pregnancy prevention, and more than one-third said they never
discussed STI prevention with their sexual partners, increasing their vulnerability to poor sexual health outcomes. Educational efforts are needed to
ensure that teenagers have the communication skills necessary to prevent
STIs and pregnancy. Discussing both of these important topics with their
partners before they have sexual intercourse is an important skill that is associated with safer sexual behavior (Crosby et al., 2002; Stone & Ingham,
2002; Whitaker et al., 1999). However, to be most effective, these conversations need to be accompanied by accurate knowledge about condoms and
contraceptives. Knowledge may also affect a teens ability or desire to have
these conversations (Rock et al., 2003; Ryan et al., 2007). Thus, sexuality

Parent-Teen Communication

13

education efforts need to encompass both accurate knowledge of prevention, and communication skills (Kirby, 2007).
Study findings can be applied in a variety of sexuality education programs and settings both by reaching parents and through developing skills.
For example, current education programs for youth can be supplemented
with specific activities for parents and teens together that emphasize communication skills. Stanton and colleagues (2000) found that, added to a
community-based youth-focused intervention, a booster designed for parents to promote parental monitoring and parent-teen communication resulted in sustained intervention effects on adolescent sexual behavior. Previous research also shows that, in the context of youth-focused interventions,
take-home activities designed to be completed by children and their parents
together, can promote parent-child communication and enhance intervention
effects (Blake et al., 2001; ODonnell et al., 2007). Another avenue to promote
parent-child communication is through the development of parent-specific
education without directly involving youth (Klein et al., 2005; Schuster et al.,
2008). Sexuality education programs that involve parents should also include
other aspects of parent-child connectedness, which is protective against adolescent sexual risk taking on its own (Markham et al., 2010) and may create
a context where these conversations can be most effective.
Sexuality education programs may also be able to incorporate tools for
teens to initiate these important conversations with their sexual partners (Yee,
Cain, Street, & Lundgren, n.d.). As involving parents in sexuality education
may not always be feasible, programs can directly teach teens skills for
communication with sexual partners even in the absence of direct parental
involvement in sexuality education programs. Indeed, teen practice with
communication, negotiation, and refusal skills has been found to be a key
characteristic of effective sexuality education curricula (Kirby, 2007).

Strengths and Limitations

This study has several strengths including a large, statewide sample, the use
of measures about both general parent-teen communication and communication about sexual health and inclusion of all sexual partners, not just
sexual debut. However, findings should be interpreted in light of study limitations. First, our measures of parent-teen communication rely solely on
student self-report, which may not accurately represent actual discussions.
Previous research has shown that there are often discrepancies between how
teens and their parents experience and report communication (Jaccard, Dittus, & Gordon, 1998). These measures also do not provide information about
the quality or the content of the communication. Second, the MSS does not
include items about the type of relationship between the adolescent and
their sexual partners (e.g., steady or casual partner), which could influence

14

M. Schonfeld Hicks et al.

partner communication and sexual risk. Third, our analytic sample was based
on student self-report of ever having sexual intercourse or sex. The MSS did
not define sexual intercourse and as a result, students may have interpreted
it in different ways. For example, some students may not have considered
oral sex to be sex. This item may also lead to further exclusion of sexual
minorities such as lesbian, gay, and bisexual youth who may be unclear of
whether their sexual behavior fits the intended definition of sex. Further,
our data did not allow us to explore partner specific communication about
risk prevention. It is possible that some students who reported not discussing
pregnancy prevention were in same-sex relationships where this would not
be a priority.
This sample may also exclude students with lower reading skills, as the
outcome measures were located at the end of the survey instrument. Students with missing sexual activity data have characteristics and behaviors that
differ from this sample; they are more likely to be male, younger, non-white,
get free or reduced-price lunch and have no future education plan. They are
also slightly less likely to be able to talk with their mother/father. We adjusted for all these characteristics in the multivariable models, which reduces
our concern about bias due to the missing data. Finally, while the sample reflects the general demographics of Minnesota students, it may have
limited generalizability to other young people outside of Minnesota or the
Midwest.

CONCLUSION
Parents play a critical role in young peoples lives. Promoting and strengthening parent-teen communication not only about sexual health but also about
everyday life may be a promising, and desirable, way to promote adolescent
sexual health. Identifying strategies for reaching those teens at greatest risk
for not communicating with their parents and developing effective ways to
support them in this behavior should be a priority for both research and programs. In addition to strengthening parent-teen communication, we need to
develop teenagers communication skills so they can confidently talk with
their partners about STI and pregnancy prevention and engage in healthier
sexual behaviors.

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