Introduction

Although numerous prevention methods exist to promote healthy sexual behavior among adolescents, a widely established practice has been to increase dialogue between parents and children about sex-related topics. This approach is especially prevalent given that young people consider parents to be significant sources of sex education (Albert 2010; Bates and Joubert 1993; Somers and Vollmar 2006). Parent–child communication about sex-related themes is a relevant aspect of public health promotion because these conversations can shape an adolescent’s attitudes, beliefs, and behaviors. More specifically, information and values received from such discourse has the potential to contribute to a youth’s decision to either engage in or abstain from sexual activity (Martino et al. 2008). Existing evidence suggests that there is a positive association between increased positive communication about sex and decreased sexual behavior (Blake et al. 2001; Miller and Whitaker 2001). The benefits of having parents talk with their children about sexual matters include youth deferring from early sexual activity, having fewer sexual partners, and increased likelihood of youth using contraceptives (Albert 2010; DiClemente et al. 2001; Fogarty and Wyatt 2006).

Despite the number of findings suggesting that increased parent–child communication about sex-related topics can serve as a protective factor against increased and risky sexual behavior, few studies have examined this topic among rural populations (Blinn-Pike 2008; Jordan et al. 2000) where nonmarital birth rates among teenagers are higher compared to urban settings (36.2 % vs. 29.2 %) (Litchter et al. 2003). Additionally, the birth rates for females ages 15–19 in all regions of the United States was 52.4 births per 1,000 female adolescents. However, in rural counties, the birth rate is much higher at 57.9 births per 1,000 female adolescents (National Center for Health Statistics 2001). Such geographical differences are important contextual aspects to consider because of the many community and cultural differences between urban and rural settings.

There is increased acknowledgment that development of health attitudes and beliefs are greatly influenced by family, community, and culture (Andrulis and Brach 2007; Boyas in-press; Institute of Medicine 2004). Individuals’ sexual attitudes and beliefs develop within this context (Blake et al. 2001; Erickson 1998; Martino et al. 2008; Miller et al. 2001; Murphy-Erby et al. 2011). Although research has determined that parent–child communication is germane in the development of sexual attitudes and behaviors, there is a paucity of research among early adolescence and rural populations. As a result, there is a lack of comprehensive understanding of rural adolescents’ beliefs and attitudes on this topic (Schouten et al. 2007). We maintain that examining parent–child communication about sex-related topics among an early adolescent rural population is a significant consideration that should be more thoroughly assessed and understood (Blinn-Pike 2008; Kirkman et al. 2005; Noone and Young 2010). Disregarding such an important distinction can be problematic when trying to design and target specific adolescent interventions focusing on sexual health within these communities. Using an ecological systems framework, the aim of this study was to explore the seventh grade adolescents’ (12–13 year olds) perspective regarding various predictors related to parent–child communication about sex-related topics within a rural community sample. Seventh grade students were selected because research has suggested that beginning sexual health communication early in adolescence could be helpful to youth in developing more positive sexual attitudes and behaviors (Byers et al. 2003; Kaiser Foundation 2007; Kotchick et al. 2001). This is especially necessary given that early adolescence is a period of exploration and experimentation (Morrison-Beedy et al. 2008). Additionally, intervening with younger adolescents is necessary for the prevention of later sexual health problems (L’ Engle and Jackson 2008).

Background and Significance

Studies have shown that parents’ development of a positive relationship and communication with their youth are associated with a reduction in the youths’ risky sexual behavioral practices and an increase in healthy sexual behavior (Dittus et al. 2004; Martino et al. 2008; Miller et al. 2001; Tannenbaum 2002; Somers and Vollmar 2006). Open communication of sex-related topics is defined as conversations between two people who feel comfortable and are not overly avoidant or overly embarrassed and negative (DiIorio et al. 1999; Feldman and Rosenthal 2000; Kirkman et al. 2005; Lefkowitz et al. 2004). Some parents assume that open communication about sex might lead to increased teen sexual behavior, even though research shows the contrary to be true (Guzman et al. 2003). Sexual communication also becomes easier and more effective in preventing sexual risk-taking when it builds on a foundation of more open communication, regardless of the topic (Jaccard et al. 2000; Feldman and Rosenthal 2000; Tannenbaum 2002; Somers and Vollmar 2006).

Open communication is subjective, dependent on the communicators’ or receivers’ perceptions (Kirkman et al. 2005). Parental efforts in communicating about sexual topics can be inhibited when an adolescent has a negative belief about these discussions; therefore, understanding the adolescents’ perspective is imperative (Schouten et al. 2007). Frequency and quality of sex communication are also important factors to consider when understanding the teens’ perspective. Research has determined that it is not just the breadth of sexual health communication but its frequent repetition that influences the child’s perception of relationship closeness and openness of communication (Aspy et al. 2006; Hutchinson et al. 2003; Martino et al. 2008). Such sexual communication patterns have been associated with the delay of intercourse (DiClemente et al. 2001; DiIorio et al. 1999; Hutchinson et al. 2003; Karofsky et al. 2001; Morrison-Beedy et al. 2008; Romer et al. 1999), and if the adolescents decide to have intercourse they tend to use contraception (Whitaker et al. 1999; Blake et al. 2001) and have fewer partners (Holtzman and Robinson 1995). Lastly, studies have shown that open communication patterns about general topics contribute not only to increased sex-related communication (Feldman and Rosenthal 2000; Lehr et al. 2005; Raffaelli et al. 1998) but also healthier sex behavior in youth (Tupa 2000), particularly when the youth perceived their relationship with their parent to be positive (Afifi et al. 2008; Tannenbaum 2002).

When exploring sexual behavior or beliefs of youth, family cohesion or closeness is often associated with a pattern of open communication with parents (Somers and Vollmar 2006; Tupa 2000). Other important factors when exploring the family closeness composite include families that spend time with one another and the perceived quality of the parent–child relationship. Various studies have reported that higher family cohesion or closeness is predictive of lower youth sexual risk-taking (Regnerus 2009). Regnerus (2009) suggests that a more influential determinant of avoiding risky sexual behavior is how connected the youth are to a supportive family and community. Similar findings were seen when exploring the perceived quality of the parents’ relationship with the youth. Results concluded that relationship quality significantly moderated not only parent–child communication but also youth sexual behavior (Tannenbaum 2002). Hierarchical regression analyses revealed that youth from this study who evaluated their relationships with their parents as supportive and positive and reported an open communication process predicted healthier sex behavior. Interestingly, those youth who reported a poor relationship and greater levels of communication content predicted riskier behavior. Regnerus (2009) concluded that families that enjoy one another’s company by having fun together decrease the likelihood of youth sexual behavior. However, when exploring father and son communication about sex topics, Lehr et al. (2005) came to a different conclusion. Increased father contact resulted in decreased sex information sharing but high perceived closeness, and general communication predicted an increase in communication about sex.

Lastly, family structure is a factor that may influence the likelihood of sexual attitudes and behaviors. Although a number of factors determine an individuals’ family structure, for the purpose of the current investigation, family structure was defined as whether the adolescent comes from a single-parent or a two-parent home. Pearson et al. (2006) found that adolescents who were not living in two parent households were 40–198 % more likely to have sex than their peers who living in two biological parents. Similarly, Manlove et al. (2007) found that teen girls living with two biological parents were less likely to have sex with older partners and more likely to remain abstinent compared to teen girls who did not live in two parent households. Benda and Corwyn (1999a) contended that adolescents reared in single-parent households are more likely to have increased sexual exploration because the stresses and deficits of poverty typically lessen the emotional and social capital of single parents to provide the nurturance and supervision that restrain natural sexual desires for gratification. From existing literature, we maintain that this lack of nurturance and supervision could preclude parents from talking to their children about sex-related topics; however, there is insufficient empirical evidence that determines how family structure shapes dialogues of sex communication between parents and children.

Studies have consistently recognized the importance of one’s peers and their influence on youths’ beliefs about sex and sexual behavior (Kirby 2002; Lefkowitz and Espinosa-Hernandez 2007; Potard et al. 2008). Both males and females report they are more comfortable communicating about sex with their peers than with their parents (DiIorio et al. 1999). Using the National Longitudinal Study of Adolescent Health, Sieving et al. (2006) found that youth who became sexually active had a greater involvement with friends, particularly those peers who were sexually active themselves. In support, Potard et al. (2008) reported that sexual permissiveness of peers is associated with higher frequency of sexual practices considered risky.

Due to the limited research exploring sexual attitudes, beliefs, and behavior in rural communities, it is not clear whether differences exist between urban and rural youth (Blinn-Pike et al. 2004; U.S. Census Bureau 2003). A longitudinal study by Blinn-Pike et al. (2004) compared sexual beliefs of rural youth with urban youth and found significant differences, including (a) protection during sex (rural youth more likely); (b) use of alcohol and drugs during sex (rural youth more likely); (c) comfort level talking to parents (urban youth more likely); and (d) parent–child communication about sex (urban youth more likely). Another comparison study evaluating the differences between urban and rural youth concluded that even though rural youth knew more about HIV prevention, they were twice as likely to engage in sexually risky behavior and to discount their own personal risk in contracting a sexually transmitted disease (U.S. Census U.S. Census Bureau 2003). Jordan et al. (2000) focused specifically on a rural population, assessing the parents’ perceptions of characteristics, content, and comfort level of discussions about sexual issues with their teens. Parents reported that 93 % of them had talked to the teen about sex and 65 % of them talked about being comfortable talking about these issues. The majority of issues discussed were responsibilities about being a parent (46 %), STDs (40 %), dating/relationship behavior (37 %), and not having sex until marriage (36 %). This research is limited in that only parents were surveyed, not youth. Examining the process of parent–child sexual communication through a rural youth’s perception remains largely unexplored.

In urban studies, the gender of both the parent and the adolescent affects the amount of sexual communication and the topics covered (Schouten et al. 2007). Daughters generally report, more than sons, a greater frequency of sex-related discussions with their parents (Feldman and Rosenthal 2000; Lefkowitz and Espinosa-Hernandez 2007; Raffaelli and Green 2003). Mothers tended to communicate to both their sons and daughters about sexual behavior more than fathers, and sometimes even more than the youths’ peers (Raffaelli and Green 2003). Female adolescents discussed the various negative consequences of sexual activity and developmental issues with their parents more frequently than male adolescents did (Dilorio and Hockenberry-Eaton 1996; Lefkowitz et al. 1996) and male adolescents’ conversations were usually around STDs and condom use (DiIorio et al. 1999).

Theoretical Underpinnings

Theories of human behavior facilitate our understanding of why people behave the way they do and provide a context for understanding their actions. In that same vein, this investigation is supported by the ecological systems theory. Ecological systems theory (Bronfenbrenner 1979) underscores the importance of comprehending the environment in which the individual lives that shapes their development and guides a youth’s interaction with the environment. This contextual lens incorporates the various meso and macro systems, including but not limited to a person’s school, family, and community. Subsequently, these assorted elements become important when viewing youths’ sexual beliefs and attitudes about sex. Additionally, this perspective identifies the importance of cultural context as a potential factor that could shape a youth’s behavior. Culture establishes cultural scripts that may delineate expectations of what are appropriate and acceptable behaviors to which the individual has to subscribe (Faulker 2003), for example, condoning sexual behavior among adolescent boys but not girls (Benda and Corwyn 1999b). Paquette and Ryan (2001) maintain that among children, culture influences them by way of communication of values and norms their parents receive from other structures within the meso- and exosystem. Therefore, from this theory we have come to understand that sexual behavior may be shaped by personal knowledge, skills, attitudes, interpersonal relationships, and environmental influences, in particular family, social relationships, and the broader community.

Although research related to sex communication is burgeoning, little of it has focused on identifying factors that are associated with increased levels of communication about sex-related topics among rural youth. The primary objective of this study was to examine the perception of parent–child communication levels of 252 rural youth located in Arkansas. Arkansas continues to boast some of the highest teen pregnancy rates in the United States. In 2006, Arkansas had the fifth highest number of teen mothers per 1,000 girls ages 15–19 (Annie Casey Foundation 2006). According to this report, the teen pregnancy rate in Arkansas for girls aged 15–19 was 106 per 1,000 girls compared with the U.S. rate of 78 per 1,000 girls. This theory and existing empirical research informs hypotheses about how sociodemographic, familial, and situational predictors shape youths’ perception of frequency of parent–child communication about sex. Based on existing literature (Hutchinson 2002; National Campaign to Prevent Teen Pregnancy 2001; O’Sullivan et al. 2001), we hypothesized that non-Hispanic White adolescents would report higher levels of frequency of sex-related communication than adolescents of color. Given that adolescents are influenced by their peers (Potard et al. 2008; Sieving et al. 2006), we hypothesized that engage in less negative peer influences would report higher levels of frequency of sex-related communication than adolescents who engaged in more negative peer influences. Lastly, given the influence of parents (Albert 2010; Bates and Joubert 1993; Somers and Vollmar 2006), we hypothesized that adolescents with higher family functioning (operationalized as closeness, time spent with parents, and comfort level discussing life issues) were more likely to report higher levels of frequency of communicating about sex-related topics than adolescents who expressed lower levels of family functioning.

Method

Sample and Data Collection

The sample for this study came from youth involved in Voices 4 Healthy Choices Project (V4HC). V4HC was conceptualized as a community-based approach to promoting adolescent sexual abstinence. The project developed out of Healthy Connections, Inc., a health center located in Polk County, Arkansas. In September of 2007 and 2008, a recruitment invitation and flyer was sent home with all seventh grade students in the partner schools. The invitation asked parents and children to attend a dinner and orientation meeting. The flyer provided parents and students a brief overview of the project. During the meeting, an orientation to the program was provided, including a description of the research purpose, program, protocol, and procedures. Translation services were provided to Spanish-speaking parents and all written materials distributed during orientation were available in both English and Spanish. At the end of the meeting, parents and children had the opportunity to sign the permission and parental consent forms. It was explained to all attendees that participants would be randomly selected, meaning that their signature did not guarantee they would be selected to participate. To encourage attendance, two single-drawing door prizes valued at $30 were offered.

The sampling frame consisted of roster sheets of all seventh grade students in our partner schools. Names of all students were entered into a statistical program in order to randomly select participants. Following the recruitment meeting, only parents of those students randomly selected to participate were sent a formal letter for participation, explaining again the program, procedures, and protocol. The package also included formal letters of permission and informed consent. Parents were instructed to send the permission and informed consent forms back with the child to give to the counselor assigned by each school. Once parental permission had been granted, child assent was also established.

Informed consent authorizing participation in this study was provided to participants along with the self-report questionnaire. Study participants voluntarily completed a roughly 60-min self-administered questionnaire developed primarily from established and validated instruments. Data were collected face-to-face by members of the research team. Respondents received a research incentive of a $10 gift card. Institutional Review Board permission was obtained by means of a full committee review in order to ensure minimal risk to study participants. Data analyzed in the current study come from all youth who participated in the V4HC baseline data collection session.

In total, 252 students participated in the study. Among the overall sample, the mean age of participants was 12.44 years; 125 were girls and 127 were boys. The participants predominantly self-identified as non-Hispanic white (73 %), 11 % self-identified as Native American, whereas 13 % self-identified as Latinos/Hispanics, and 3 % were a combination of other races/ethnicities. A majority of participants lived in a two-parent household (75 %).

Measures

Gender was dichotomized: (1) = females; (0) = males. Since a majority of respondents were non-Hispanic whites, we grouped Latinas/os, African Americans, and Native Americans together. Race/Ethnicity was dichotomized: (1) = non-Hispanic whites; (0) = youth of color. Family structure was a dichotomous variable: (0) = lives with both parents; (1) = does not live with both parents. Closeness to parents was measured by two 4-point Likert-scale items: how close do you feel to her and how close do you feel to him. Spending enough time with parents was measured by two 3-category items: does she spend enough time with you and does he spend enough time with you: (a) not enough time, but I don’t want more; (b) not enough time, I wish they spent more time with me; (c) they spend enough time with me. General communication pattern when talking with parents was measured by four single, 3-category items, asked for mother and father separately: (a) I am comfortable talking with him and her about things that happen in school and (b) about things that happen in my life: (1) hardly ever true, (2) sometimes true, and (3) mostly true. The questions that related to comfort level when talking with mother and father were aggregated separately. Peer social relationships were measured by two single items: how many of your friends drink alcohol like beer, wine, or liquor and how many of your friends have tried marijuana or other drugs. These items were measured as: (1) none, (2) a few, (3) some, and (4) most. These items were aggregated to develop a peer social relationship scale. The peer social relationship scale demonstrated moderate internal consistency (Cronbach’s alpha = .71).

The Parent–Adolescent Communication Scale (PACS) was created with the intent of assessing adolescents’ self-perceived frequency of communicating about sex-related topics with their parents. This is a 5-item scale that will be sum of the answers to the questions, “In the past 6 months, how often have you and your parent(s) talked about the following things: (a) sex, (b) how to use condoms, (c) protecting yourself from sexually transmitted diseases (STDs), (d) protecting yourself from the AIDS virus, (e) protecting yourself from becoming pregnant?” Each item required a response based on a 4-point Likert-type scale: 1 (never), 2 (rarely), 3 (sometimes), and 4 (often). All items were coded so that higher values indicate higher frequency of parent–child communication. It has demonstrated above-average internal consistency. The Cronbach’s alpha for the PACS was .88 at baseline and .89 at the 6-month follow-up assessment (Sales et al. 2008). In the current study, the PACS demonstrated high internal consistency (Cronbach’s alpha = .82).

Analytic Strategy

Descriptive analyses were computed on all of the variables used in this study, using the Statistical Package for the Social Sciences (SPSS) 19.0 software program. During this stage, data integrity was maintained by examining each variable to assess departure from normality and check for missing data. Missing data were handled by using a regression imputation method. Descriptive statistics were generated to discern the study sample in terms of sociodemographic characteristics. Bivariate analyses were computed by way of Pearson’s r zero-order correlations to establish the direction and magnitude of the relationship between predictor variables and parent–child communication scores. Additionally, independent sample t-tests were computed to determine if significant differences exist among dichotomized variables examined in the study. Finally, a multiple regression model was computed to determine if a statistically significant association exists between the criterion and predictor variables. All predictor variables were entered into the model concurrently since we did not hypothesize a priori the relative significance of each predictor variable and its relation to communication levels. Statistical significance was measured at the 95 % confidence interval level (p = <.05).

Results

Results of the univariate statistics suggest that the youth in our sample reported feeling close to their mothers and fathers (see Table 1). In all, 85 % reported feeling pretty close or very close to their mothers, while 78 % reported either feeling very close or pretty close to their fathers. When it came to spending time together, 73 % reported that their mothers spent enough time with them, while 65 % of youth reported that they felt their fathers spent enough time with them. When it came to comfort level in discussing events that happen in a youth’s life, the participants reported mixed feelings. Sixty-two percent and 53 % of the youth reported that they felt comfortable talking with their mother and father respectively about things that happen in school. Even fewer felt comfortable talking with mothers and fathers about things that happen in their lives. Results indicate that only 47 % felt comfortable talking to their mothers about events that happen in their lives and 45 % stated that they felt comfortable talking with their fathers.

Table 1 Sample Demographics (N = 252)
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Turning to communication levels, the sample could be characterized as having very little parent–child interaction about sex-related topics (see Table 2). Roughly 66 % report either rarely or never talking to their parents about sex. Moreover, even fewer youth perceived talking to their parents about how to use condoms. The youth reported that 75 % never discussed how to use condoms with their parents, while another 15 % reported rarely talking to their parents about how to use condoms. With regards to talking with their parents about protecting oneself from STDs, 65 % of adolescents reported rarely or never talking about this topic. When it came to talking about protecting oneself from the AIDS virus, 51 % reported never talking to their parents about this, while another 15 % reported rarely talking about this topic with their parents. When it came to talking to parents about ways to avoid getting pregnant, 67 % of youth reported that their parents either rarely or never talked to them about this subject.

Table 2 Parent–adolescent communication scale
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Results of the zero-order correlations suggest that closeness and comfort levels were significantly associated with parent–child communication about sex. More specifically, feelings of closeness to parent were also significantly associated with increased levels of parent–child communication about sex. However, this was true only for feelings for mothers, not fathers. Youth who reported increased feelings of closeness to their mothers also reported higher levels of communication about sex-related topics (r = .151). Comfort levels also were significantly associated with increased communication levels; however, this was only true for mothers and not fathers. Youth who reported feeling more comfortable talking with their mothers also reported increased levels of sex communication (r = .195). Results of the t-test suggest that parent–child communication about sex significantly varied by race/ethnicity and gender, but not by family structure, spending time with either mother or father. In terms of race/ethnicity, adolescents of color (M = 10.93, SD = 4.56) reported significantly higher levels of sex communication compared to non-Hispanic white adolescents (M = 9.04, SD = 9.04). In terms of gender, adolescent boys (M = 8.51, SD = 3.72) reported significantly lower levels of parent–child communication about sex compared to girls (M = 10.34, SD = 4.19).

The results of the multivariate regression model show that the proposed model was significant (F = 3.660, p = <.001) and three factors significantly predicted parent–child communication levels about sex-related topics (see Table 3). The model accounted for roughly 15 % of the variance. Multivariate regression results show that being a female, being a youth of color, closeness to fathers and spending time with father significantly predicted frequency levels of sex-related communication. In the multivariate regression model, fathers played a greater role than at the bivariate level. In fact, time spent with fathers and closeness levels emerged as the strongest relationships in predicting communication levels. Youth who reported spending less time with their fathers but did not want any more time with them predicted lower levels of parent–child communication compared to those who reported spending enough time with their fathers (β = −.36). Additionally, youth who reported feeling closer to their fathers also reported lower levels of communication about sex-related topics compared to youth who reported not feeling very close to their fathers (β = −.31). Among our sample, girls were significantly more likely to report greater levels of communication compared to boys (β = .26). Race/ethnicity remained significant in the multivariate model; youth of color reported higher levels of parent–child interactions about sex-related topics compared to non-Hispanic White youth of color (β = .18). Contrary to our hypotheses, neither family structure, time spent with mother, closeness to neither parent, nor comfort level was significantly predictive of frequency levels of sex-related communication between parent and child.

Table 3 Multiple regression analysis of predictors of parent–child communication about sex
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Discussion

The current study sought to examine whether familial, situational, and sociodemographic factors were associated with youths’ perceptions in the areas of frequency of communication with parents about multiple sex-related topics among rural youth. Highlighted in the results are some variables related to the relationship between these youth and parents. Even though most of the youth felt close to their parents, many still reported little comfort when talking to them about life’s issues. On the other hand, many of the youth responded positively on time spent with their parents although this response decreased when looking at the time spent with their fathers. Regarding communication, approximately 75 % of the youth reported no or very little communication with their parents about sex-related topics. This is contrary to another rural study exploring frequency of parent–child sexual communication, which found higher levels of frequency of sex-related conversations (Jordan et al. 2000). However, Jordan and colleagues’ study was based on parent perspectives and not the youths’. These differences highlight the complexity of examining patterns of parent–child communication. There may be a disconnect between what parents report versus the perceptions of youth.

Turning to frequency of sex-related communication, our results are not consistent with the existing literature from rural populations (Jordan et al. 2000); however, it is consistent with the broader findings about frequency of sex communication (Rafaelli et al. 1998). Our findings suggest that there are low levels of overall frequency regarding sex-related communication among rural youth and parents. As for content, our findings show that when parents are speaking to their children about these sensitive topics, they are speaking to their children about sex. However, other more sensitive and important topics are being left out, such as condom use, protection against contracting an STD, and ways to avoid getting pregnant. This is significant given the recent rise in incidence of infection of STDs, such as chlamydia and gonorrhea, among young people aged 15–19 years old (Centers for Disease Control 2010). National data suggest that a great deal of new incidences of sexually transmitted infections is occurring in Arkansas and other southern states (Centers for Disease Control 2010). Social workers and health professionals should raise parents’ awareness of such trends and encourage parents to consider equipping their children with comprehensive approaches towards increasing protection, including condom use and other methods of reducing sexual risks of contracting STDs. These findings imply that social workers and other health professionals should ensure that parents are encouraged to talk to their children more holistically about sexual health prevention and protection.

Our multivariate findings show that being a female, being a youth of color, level of closeness to father and spending time with fathers predicted levels of sex-related communication between parent and child. Our results suggest that fathers play a major role in determining frequency of sex-related communication. In fact, our results show that time spent with fathers and closeness levels emerged as the strongest relationship in predicting frequency levels of communication. However, their role is complex. For those youth who did not spend enough time with their fathers but did not want more time reported significantly lower levels of frequency of sex communication compared to those who believed their fathers spent enough time with them. However, contrary to our hypothesis but supportive of existing research (Lehr et al. 2005), youth who believed they had a closer relationship with their fathers also reported significantly lower levels of sex-related communication. Although other research suggest parent–child closeness is positively associated with abstinence, postponing intercourse, and using contraception consistently (National Campaign to Prevent Teen Pregnancy 2008), that is not true of frequency of sex-related topics. This finding in some way suggests that strength of relationship with fathers may not necessarily translate to higher frequency levels of sex communication as it does with mothers (Tupa 2000).

As hypothesized and consistent with other studies, girls reported a higher frequency of sex-related communication with their parents than boys (Feldman and Rosenthal 2000; Lefkowitz and Espinosa-Hernandez 2007; Raffaelli and Green 2003). This finding could suggest that boys are possibly discussing sex-related issues with their peers as opposed to their parents. This could be problematic given that peers are more likely to support sexual norms and scripts that may encourage the acceleration of sexual activity (L’Engle et al. 2006). Moreover, increased sexual communication with friends has been found to be associated with higher susceptibility and higher odds of initiating sexual intercourse (L’ Engle and Jackson 2008).

Another important distinction seen in the current study is the result that non-Hispanic White youth reported less sexual communication with their parents. Many other studies have reported that Latina/o and African American parents communicate less with their children around these topics (Hutchinson 2002; National Campaign to Prevent Teen Pregnancy 2001; O’Sullivan et al. 2001). This finding could be related to the fact that parents of color in rural areas may speak to their children more about sex-related topics because they may perceive that there are not enough positive social outlets for children. This perception, whether real or not, might influence them to talk about the need to engage in healthier social behavior, such as remaining abstinent and avoiding sexual behaviors that might put a youth at risk of getting pregnant or contracting an STD.

Using ecological systems theory as a guiding framework, these findings hold implications for the design of teen pregnancy prevention programs and policies. Many health promotion programs have responded to literature that recognizes the significance of familial influences by incorporating parental components in their program designs. The literature suggests many differences between mothers and fathers in their interactions with children, including the level of involvement and types of activities they engage in. We also know that fathers interact differently with their sons and daughters and the effect of their relationship is different for boys and girls (DiIorio et al. 1999), yet many teen pregnancy prevention programs use curriculums that are not sensitive to these differences. Our findings, along with literature indicating the association between father involvement and positive outcomes for children (Flouri 2005), suggest a need for more dynamic curricula and policies that require strategic efforts to engage fathers in teen pregnancy prevention efforts.

Critical to this effort are curricula that include a psycho-educational component to provide fathers with an understanding of the content and topics that are helpful in addressing a deeper level of understanding of the personal development needs of their sons and daughters. Also needed in the curricula is a component to promote socialization between fathers and children. Promoting socialization may help to increase the children’s feelings of closeness, comfort, and frequency of sex-related communication with their fathers.

Existing research has established that, in some ways, mothers have been deemed the primary responsible person in the household to facilitate sex education and communication (Kirkman et al. 2002; Raffaelli and Green 2003; Raffaelli et al. 1998). However, to successfully increase communication about sex between parents and children, community-based pregnancy prevention efforts will require recruitment and retention strategies that target fathers and creative mechanisms for changing the attitudes that children have about their fathers when it comes to sex communication. This process can be complicated by the circumstances of many fathers such as poverty, holding multiple jobs, and a lack of transportation. These are major issues in rural areas and may impede the fathers’ motivation or ability to engage in a community-based program. As a first step to addressing such barriers, we encourage practitioners and policy advocates of community-based teen pregnancy prevention programs to dialogue and explore collaborations with their peers engaged in fatherhood initiatives who are also exploring ways to engage fathers to promote child well-being. Ensuring that teen pregnancy prevention programs incorporate strategies to increase the amount of time spent between fathers and their children communicating about sex-related issues can serve as a necessary protective factor against increased and risky sexual behavior. Thus, it is our desire that results of this study lead to the development and subsequent evaluation of targeted interventions and policies aimed at involving fathers in teen pregnancy prevention efforts in rural areas.

Our findings also highlight the need for parents to talk more with their sons about sex-related topics. Prevention efforts should be created with the idea that relative to girls, boys are not communicating as frequently with their parents about sex-related topics. As social workers and health practitioners develop programs that target early adolescents in rural settings, perhaps increasing the frequency of activities between boys and parents could begin to address this issue. Given that as boys mature they turn to their peers for sex-related information, prevention programs will have to make more concerted efforts to keep the dialogues flowing and open between boys and parents in order to have parents remain the primary sources of sexual socialization.

Limitations

Although we contribute to the knowledge base of parent–child communication about sex-related topics by surveying perceptions of rural youth, a number of limitations should be acknowledged. First, the cross-sectional nature of the current data does not allow for any causal inferences. To truly isolate the underlying causal linkages of sociodemographic characteristics and familial and situation characteristics with frequency of parent–child communication, a longitudinal design is needed. Second, it is plausible that using a different measure of sex communication could have altered the results. Additionally, the PACS measure did not ask the youth to specify which parent he/she was communicating with about these topics. Given that there is gender concordance with regard to sex communication, perhaps identifying which parent these conversations were taking place with could have provided greater insight. Third, even though we randomly selected our participants, our sampling frame was limited to only those schools who had agreed to be a collaborative partner. The school district in the rural community where the study took place did not have many schools. Two out of the five schools in the county elected not to participate in the current study. Last, our homogenous sample and limited geographic location could have biased the results (Tabachnick and Fidell 2001).

Conclusion

Results of our investigation suggest that multiple factors influence frequency levels of sex-related communication between parents and children. Our findings show that situational and sociodemographic differences play a significant role in predicting frequency levels of sex communication. Intervention programs should be planned with such differences in mind. Programs that work toward understanding racial and ethnic differences, gender differences in communication patterns, and complexity in the roles played by fathers and mothers are more likely to have success in increasing frequency of sex communication in rural populations. Given that culture and context play a major role in the development of various beliefs and attitudes (Andrulis and Brach 2007; Boyas in press; Institute of Medicine 2004), future studies should continue to examine distal and proximal factors related to culture and context that may play a role in determining how parents and youth form communication about sex. Doing so may inform practitioners as to how to support parents and children in rural communities as they journey through the challenges associated with talking about sensitive topics such as sexual health.