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Original Investigation
July 29, 2019

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis

Author Affiliations
  • 1North Carolina State University, Raleigh
  • 2University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Pediatr. 2019;173(9):866-877. doi:10.1001/jamapediatrics.2019.2324
Key Points

Question  Are parent-based sexual health interventions associated with improved adolescent sexual health outcomes?

Findings  This meta-analysis synthesized the results of 31 randomized clinical trials comprising 12 464 adolescent participants. Across studies there was a significant association of parent-based interventions with improved condom use and parent-child sexual communication compared with control conditions, but there was no significant mean association of these interventions with delaying adolescents’ sexual activity.

Meaning  Overall, parent-based interventions may improve several aspects of adolescents’ sexual health and decision-making.

Abstract

Importance  Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized.

Objective  To examine the association of parent-based sexual health interventions with 3 primary youth outcomes—delayed sexual activity, condom use, and parent-child sexual communication—as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness.

Data Sources  A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles.

Study Selection  Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English.

Data Extraction and Synthesis  Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables.

Main Outcomes and Measures  The primary outcomes were delayed sexual activity, condom use, and sexual communication.

Results  Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = −0.06; 95% CI, −0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose.

Conclusions and Relevance  Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.

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