Parenting Interventions on Adolescent Sexual & ReproductiveHealth: A Systematic Review of the Literature Público

Abstract

Introduction: Adolescent sexual risk behavior is of concern globally. Young people account for an estimated 40% of all new HIV infections globally and unwanted pregnancies lead to three million unsafe abortions among adolescents every year. Risk factors include early sexual initiation and non-use of condoms. However, one major gap in sexual risk prevention and reduction efforts has been the limited attention paid to parents who can directly influence adolescent behaviors.

Purpose: The purpose of this thesis is to review relevant literature on parenting interventions related to adolescent sexual & reproductive health with the purpose of assessing the evidence for their effectiveness and identifying components of effective interventions that improve parenting skills and lead to positive adolescent-health outcomes.

Methodology: Three databases - PubMed, Google Scholar and Web of Science - were searched for relevant articles published from 1990 to 2012. The search identified 17 review articles with 14 employing a randomized controlled trial design. Interventions effectiveness was assessed qualitatively based on each program's content and study design characteristics. The wide range of components of the interventions and the variability in outcome measures did not permit quantitative meta-analysis of the relevant data.

Results: The interventions reviewed targeted a range of different age groups and populations, and employed a variety of different modalities. The parent-focused interventions were more effective than family-focused interventions. While some interventions promoted abstinence only, others took a more comprehensive approach to sexuality education. In both cases, parents demonstrated the potential to influence adolescent behavior. Effective interventions addressed multiple behavioral factors such as drug and alcohol use, parent-child communication, and other parenting practices including monitoring, family support and parent-child relationship.

Conclusions: Overall, the review demonstrated that parents can be a very valuable resource for sexual health education if they are given the right tools and support. A conceptual model is proposed that may be a useful guide for the design and evaluation of future interventions. The standardization of outcome measures would permit easy comparison across studies. Stronger evidence of the long-term impact of interventions is needed through longitudinal randomized controlled trials that cover the adolescent lifecycle.

Table of Contents

Chapter 1 Introduction...1

Introduction and Rationale...1

Parenting Intervention...6

Problem Statement...9

Purpose Statement...9

Significance Statement...9

Chapter 2 Methodology...10

Introduction...10

Research Design and Study Characteristics...11

Data Extraction and Analysis...12

Outcome Measures...13

Chapter 3 Results...14

Introduction...14

Summary of Intervention Study Characteristics...15

Key Program Components and Outcome Effects...16

Chapter 4 Discussion and Conclusion...37

Introduction...37

Intervention Effectiveness...37

Primary vs. Secondary Outcomes...37

Impact of Parent-focused Interventions...38

Parenting Practices and Impact on Sexual Behavior Change...40

Abstinence-only vs. Comprehensive Sexuality Education...43

Multi-Behavior Programming...46

Implications for Public Health Practice and Policy...46

Limitations of Current Study...52

Gaps in Intervention Evidence...52

Recommendation for Future Research...54

Conclusion...56

References...71

Tables

Figures

Tables

Table 1 Intervention Study Characteristics...59

Table 2 Intervention Outcome Measures and Effects...62

Figures

Figure 1 McLeroy's Ecological Model of Health Behavior...5

Figure 2 Sample Search Strategy for PubMed...10

Figure 3 Systematic Review Flow Diagrams...12

Figure 4 Conceptual Model of Parental Influence on Adolescent Sexual Risk Behavior...50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Education, Health Psychology, Behavioral Sociology, Individual and Family Studies
Palavra-chave	parenting interventions adolescent health parent-child communication sexual risk behavior
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University

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