Download PowerPoint Template Demonstration

Parent-Adolescent Communication
about Sex in Latino Families:
Strategies for Practitioners
November 17, 2010
Vincent Guilamo-Ramos, Ph.D.
Professor
New York University
Silver School of Social Work
Overview
 Epidemiological Profile of Teen Pregnancy,
HIV/AIDS, Sexually Transmitted Infections (STIs)
 Current Approaches for Addressing Reproductive
and Sexual Behavior Outcomes
 Parent-Adolescent Communication and Sexual
Behavior Among Latino Families
Part I:
Profile of Latino Teen Pregnancy,
HIV/AIDS, & Sexually
Transmitted Diseases
Teen Pregnancy in the U.S.
 The United States has the highest rates of teen
pregnancy and birth among developed countries.
 Each year, approximately 750,000 women aged 1519 become pregnant.
(Guttenmacher Institute, 2010; National Campaign, 2006)
U.S. Teen Pregnancy Country Comparison
 The U.S. teen birth rate is:
 1.5 times higher than the teen birth rate in the UK
(26.7 per 1,000), which has the highest teen birth rate
in Europe.
 More than 3 times as high as the teen birth rate in
Canada (13.3 per 1,000).
 More than 8 times higher than the teen birth rate in
Japan (5.1 per 1,000)
 Seven time higher than Denmark (5.9 per 1,000)
Teen Pregnancy Among Latinos
 Since 1995, Latina teens have had the highest teen birth
rate among all ethnic groups in the U.S.
 52% of Latinas will give birth before age twenty.
 In 2007, the birth rate for Hispanic teenagers (81.8 per
1,000 aged 15–19 years) was nearly three times the rate
for non-Hispanic white teenagers (27.2) (CDC, 2010).
(NationalCampaign.org, 2008)
Teen Pregnancy Among Latinos
 The Latino population is the largest and fastest growing
minority group in the United States.
 Although the number of teen births among Latinas has
declined, the rate of decline has been only about half of
those in other races/ethnicities (Hamilton et al., 2010).
 In Texas, the teen pregnancy rate for Latinas from 19922005 decreased by 18%, whereas the rates for Whites
and Blacks decreased by 56% and 44%, respectively
(Kost et al., 2010).
(NationalCampaign.org, 2008)
Teen Birth Rates in the U.S. by State
(CDC/NCHS, National Vital Statistics System, 2010)
Highest Teen Pregnancy Rates by State**
(CDC, 2010)
per 1,000 Girls Aged 15-19
State
Rate
United States
41.5
Mississippi
65.7
New Mexico
Texas
Oklahoma
Arizona
64.1
63.4
61.6
56.2
Kentucky
85
Tennessee
83
(**Data is based on 2008 estimates)
Teen Pregnancy in Texas
 Texas was ranked third among states with the highest
teen pregnancy rates in 2008 (CDC, 2010).
 Every ten minutes a teen in Texas becomes pregnant
(Texas Department of State Health Services, 2010).
 In Texas, the teen pregnancy rate for Latinas from 19922005 decreased by 18%, whereas the rates for Whites
and Blacks decreased by 56% and 44%, respectively
(Kost et al., 2010).
STIs Among Latinos
 In 2008, the rate of gonorrhea infections for Latinos was
twice the amount for Whites (66.8 cases per 100,000 vs.
31.0) (CDC, 2008).
 In 2008, overall rates of Chlamydia were almost three
times higher for Latinos than for Whites (510.4 cases per
100,000 vs. 173.6) (CDC, 2008).
 In 2008, the rate of syphilis cases was twice as high for
Latinos than for Whites (4.7 cases per 100,000 vs. 2.2)
(CDC, 2008).
STIs Among Teens in the United States
 Of the 18.9 million new cases of STIs each year, 9.1
million (48%) occur among 15-24 year-olds (Weinstock
et al., 2004).
 Although 15-24 year-olds represent only 25% of the
sexually active population, they acquire nearly half of all
incident STIs (Weinstock et al., 2004).
STIs Among Latino Teens
 Prevalence of Chlamydia per 100,000 people (CDC, 2007):


10-14 year olds: 55.4 among Latinos vs. 22.1 among Whites.
15-19 year olds: 1725 among Latinos vs. 750.5 among Whites.
 Rate of cases of gonorrhea per 100,000 people (MMWR, 2009):


10-14 year olds: 3.5 among Latinos vs. 0.8 among Whites.
15-19 year olds: 319.2 among Latinos vs. 208.3 among Whites.
 Rate of cases of primary and secondary syphilis per 100,000
people (MMWR, 2009):


10-14 year olds: 0 among Latinos vs. 0 among Whites.
15-19 year olds: 1.6 among Latinos vs. 0.5 among Whites.
HIV/AIDS Among Latinos
Latinos in the United States account for higher rates of new HIV
infections, AIDS cases, and people living with HIV than their White
counterparts.
 The AIDS case rate per 100,000 among Latino adults/adolescents
was the third highest of any racial/ethnic group in the U.S. in 2007—
about 3 times that of Whites.
 Latino teens, ages 13–19, account for 19% of AIDS cases among
teens. Latinos ages 20–24 account for 24% of new AIDS cases
reported among young adults, but represent 18% of U.S. young
adults, in 2007.
(Kaiser Family Foundation, 2009)
HIV/AIDS Among Latino Teens
 Rates per 100,000 population of persons living with AIDS
(50 States) (MMWR, 2009):
 10-14 year olds: 5.6 among Latinos vs. 1.3 among Whites.
 15-19 year olds: 12.2 among Latinos vs. 2.5 among Whites.
 Latino adolescents are least likely to report that they
were educated about HIV/AIDS at school (CDC, 2008).
HIV/AIDS in Texas
 The Texas Department of State Health Services has identified
HIV/AIDS as a priority area of concern (2010).
 Since 2002, the number of persons living with HIV/AIDS in Texas
has increased steadily—about 6% each year (Texas Department of
State Health Services, 2010).
 In 2002, 22.6% of people living with HIV in Texas were Latino. In
2008, 25.2% of people living with HIV in Texas were Latino (Texas
Department of State Health Services, 2010).
Ecological Content of Teen Pregnancy
Educational:
 54% of Latina teen mothers drop out of high school. The percent of
drop-outs among all races is only 34% (Perper et al., 2010).
Generational:
 Children born to teen mothers are less likely to succeed in school,
are at greater risk for poverty, and are more likely to have health and
behavioral problems (Hoffman, 2006).
Economic:
 Teen mothers more likely to be recipients of TANF within three years
of the childbirth (National Campaign, 2010).
Part II:
Current Approaches to Address
Outcomes
Limited Programs for Latino Teens
 Latino adolescents have a higher risk for unintended
pregnancies and STIs compared to other adolescents,
making evidence-based programs to reduce teenage
pregnancy particularly important for this group.
 Although Latino youth are the largest minority youth
group in the United States, research and programs for
pregnancy prevention and sexual risk reduction for this
population have significantly lagged behind (Zayas and
Witt, 2010).
The Need for Targeted Approaches
 Targeted programs are needed to address outcomes due
to the unique ecological context and behaviors of Latino
youth.
 As cultural values are often linked to sexual risk
behaviors in the Latino community, behavioral
interventions should be based on a framework that is
tailored to the culture of the target group (Villarruel, L. S.
Jemmott & J. B. Jemmott, 2005).
Unique Considerations for Latino Youth
 Contraception use
 Patterns of sexual behavior
 Characteristics of sexual partners
Contraceptive Use Among Latino Teens
 Only 10% of high school Latina females reported using
birth control before their last sex compared to 31% of
their non-Hispanic White counterparts (CDC, 2010).
 Of sexually active Latino boys, 64% reported using a
condom consistently within the past month. The same
measures for Whites and Blacks were 71% and 80%,
respectively (Abma et al., 2010).
Contraceptive Use Among Latinos in Texas
Condoms:
 In Texas, 54.3% of sexually active Latino teens reported
using a condom at last sex. The same measures for
Whites and Blacks were 59.8% and 61.8%, respectively
(CDC, 2010).
Birth Control Pills:
 In Texas, 10% of sexually active Latina teens reported
taking birth control pills at last sex. The same measures
for Whites and Blacks were 22% and 7%, respectively
(CDC, 2010).
Sexual Behavior and Latino Youth
 Only 46% of Latino teens report that they were “going
steady” with their first sexual partner. Involvement in a
romantic relationship is an important predictor!
 30% of Latino teens report that their first sexual partner
was someone other than a steady romantic partner, e.g.,
“friend” or casual partner.
 69% of Latino teens had sex prematurely regret doing it
too soon.
(Abma et al., 2010).
Sexual Partners Among Latino Teens
Age Difference:
 53% of Latina teens believe it is okay to date someone three or
more years older (Vexler, 2007).
 More than one-third of Latina teens reported that their first male
partner was four or more years older. This fraction was only one-fifth
for non-Latina teens (CDC, 2010).
 As age difference between a girl and her first partner increases, so
does the chance that first sex will be unwanted (Moore et al., 1997).
 As age difference between a girl and her first partner increases, the
likelihood of using contraception decreases (Suellentrop et al.,
2007).
Part III:
Effective Strategies:
Improving Parent-Adolescent
Communication
Approaches to Preventing
Adolescent Sexual Risk Behavior
 Many approaches on preventing adolescent sexual risk
behavior focus on adolescents directly:
 School-based prevention programs
 Clinic-based prevention programs
 Media programs
 Internet-based interventions
 Environmental interventions
 Positive youth development.
Family-Based Approaches
Family-based approaches also exist to prevent
adolescent sexual risk behavior.
Advantages:
 Research supports that parents are primary socializing agents of
children.
 Adolescents want to hear from their parents.
 Implement in context of family’s value system.
 Tailor information for parent and child.
 Flexible in timing and can be ongoing.
Family-Based Approaches
Criticisms:
 Adolescents are peer-oriented, not parent-oriented.
 Parents lack information and perspectives to be effective.
 Cannot work in dysfunctional family system.
 Parents are too busy or are considered ‘hard to reach’.
Parental Influences on
Adolescent Sexual Behavior
 Studies demonstrate that parents do have a
great influence on adolescent sexual behavior.
 Jaccard and Dittus (2001),
 Jaccard, Dodge, and Dittus (2002),
 Kotchick, Shaffer, Forehand, and Miller (2001),
 Meschke, Bartholomae, and Zentall (2000),
 Miller, Benson, and Galbraith (2001).
Parental Influences
 Family Structure
 Marital status
 Parental education
 Socioeconomic level
 Family Processes
 Parental monitoring and supervision
 Parental control and discipline
 Parental values and disapproval
 Warmth, closeness and relationship quality
 Parent-adolescent communication
Importance of
Parent-Adolescent Communication
 Majority of research supports that parent-adolescent
communication is associated with reduced
adolescent sexual risk taking (Miller et al., 2001).
 Parent-adolescent communication about sex is
associated with:
 Increased abstinence values and intentions
among adolescents (Miller et al., 1998).
 Reduced intentions to have sexual intercourse
(Guilamo-Ramos et al., 2007).
Parent-Adolescent Communication
 Latino parents want assistance talking with their
children about sex (Guilamo-Ramos et al., 2006;
Vexler, 2007).
 How can practitioners help Latino parents talk
about sex with their adolescent children?
 Help parents overcome barriers.
 Use evidence-based strategies to promote
communication
• Communication framework
Common Barriers to Communication
 Parents may feel that they lack the knowledge to talk with
their adolescent about sex (Guilamo-Ramos et al., 2008).
 Parents may be uncomfortable or embarrassed to talk with
their teen about sex (Guilamo-Ramos et al., 2008;
Meneses et al., 2006).
 Some parents think that talking won’t make a difference,
e.g., fatalismo (Guilamo-Ramos et al., 2006).
Common Barriers to Communication
 Some parents worry that talking about sex will encourage
their child to become sexually active (Guilamo-Ramos et al.,
2006).
 Parents say that they don’t know when to talk, how to talk or
what to say (Vexler, 2007).
 Generational differences: Many Latino parents were raised
in families and cultures with limited family communication
about sexuality (Guilamo-Ramos et al., 2006).
Practitioner Strategies:
Overcoming Barriers to Communication
 Improve parents’ knowledge base: give them
concrete materials and make sure they understand
the information.
 Let parents know that their children want to hear from
them (Vexler, 2007).
 Support parents’ confidence to talk with their children.
 Identify a support network: If parents are unable to
talk, is there another trusted adult who can talk to
their child?
Practitioner Strategies:
Overcoming Barriers to Communication
 Tell parents that talking makes a difference: Latino youth
are less likely to get pregnant or acquire STIs when
parents send clear messages about delaying sexual
behavior.
 Talk with parents about their feelings of embarrassment or
discomfort: Identify concrete ways to manage these
feelings.
 Address generational differences: Parents can help
adolescents negotiate the pressures associated with
living in “two worlds.”
Practice Framework for
Parent-Adolescent Communication
 Communication framework emphasizes
four key factors:
Content of communication
Context of communication
Timing of parental discussions
Frequency of parental discussions.
Content of Communication
What are parents discussing with their children?
 Parents are most likely to talk about:
 Puberty (Ancheta et al., 2005)
 Morals and values (Romo et al., 2002)
 Negative consequences (Guilamo-Ramos et al., 2007)
 Parents are less likely to talk about:
 Contraception and birth control (Raffaelli & Ontai, 2001)
 Teen’s reasons for having sex (Guilamo-Ramos et al., 2007)
 Parents talk more to girls than to boys (Guilamo-Ramos et
al., 2007)
Content of Communication
 Adolescents say they are most likely to have sex
because they believe it will have positive benefits:
 Expectations of love, closeness and physical pleasure
 Social concerns: becoming more popular at school
 Improved relationships with school peers and romantic
partners
 Expect that it will make them feel more physically attractive
(Guilamo-Ramos et al., 2007).
 Adolescents want parents to talk to both boys and girls
(Vexler, 2007).
Practitioner Strategies:
Context of Communication
 Improve parents’ knowledge base: Review materials
Help parents deliver effective messages:
 Clearly disapprove of adolescent sexual behavior
 Talk about healthy romantic relationships in adolescence
 Talk about why delaying sex is important: school and career
 Talk to girls and boys.
Practitioner Strategies:
Context of Communication
 Deliver a “Think Health, Talk Social” message to
parents:
 Motivate parents to talk by reviewing the negative
consequences
 Review the social reasons associated with adolescent
sexual behavior (Guilamo-Ramos et al., 2003).
Practitioner Strategies: Context of Communication
 Capitalize on the cultural value of personalismo, which
emphasizes honesty, personal character and inner
qualities in personal relationships.
 Help parents to:
 Be open, honest and accessible
 Stay calm during conversations about sex
 Ask open-ended questions and listen to their teen
 Show interest in their teen’s life
 Show love and affection to their teen
 Let their teen know that they want the best for them and are
on their side.
Timing of Parental Discussions
 When should parents talk?
 Many parents wait until there are clear signs that their
child is sexually active or is contemplating becoming
sexually active.
 Problem: many parents underestimate adolescent
involvement in risk behaviors, including sex.
 The best time to talk is before teens start dating or
become sexually active (Guzmán et al., 2003; O’Donnell
et al., 2006).
 Teens who talk with their parents about condoms before
the onset of sexual activity report higher rates of condom
use at first sex (Miller et al., 1998).
Practitioner Strategies:
Timing of Parental Discussions
 Let parents know that they should:
 Talk about sex before high school
 Begin talking about sex around ages 10-12.
 Help parents find a good time to talk with their teen:
 Even in the context of a busy work or family
schedule.
 Take advantage of natural teaching moments:
family/friends, TV, news, popular culture and
novelas.
Frequency of Parental Discussions
 How often should parents talk?
 The frequency of conversations is important because it can
indicate how often parents are talking with their teen about sex
(Lefkowitz et al., 2002).
 Do parents and adolescents agree on how often they talk?
 No. Parents report a greater frequency of conversations than do
adolescents (Guilamo-Ramos et al, 2007).
 However, the more that parents talk about specific sexualityrelated topics, the more likely it is that adolescents believe
parental messages on that topic (Guilamo-Ramos et al., 2007).
Practitioner Strategies:
Frequency of Parental Discussions
 Practitioners can help parents to:
 Avoid the “Big Talk” approach
 Set up regular “talk times.”
 View talking with their adolescent about sex as an ongoing
part of the parent-adolescent relationship.
 Use humor; laughter can help both parents and adolescents.
Practitioner Strategies:
Frequency of Parental Discussions
 Highlight that regular communication allows parents to:
 Consistently communicate their values
 Add new information as their child grows older
 Become more comfortable talking about sex
 Help ensure that teens internalize parent’s beliefs and values
about sex (Guilamo-Ramos & Bouris, 2008).
Parent-Based Intervention Content
Parent-Based Intervention
Practitioner Guide
National Campaign to Prevent Teen and Unintended
Pregnancy:
http://www.thenationalcampaign.org/resources/pdf/pubs/Parent_A
dolFINAL.pdf
National Conference Call Audio:
http://www.thenationalcampaign.org/espanol/CC_0304.mp3