Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial

Beth Bourdeau, Brenda A Miller, Hilary F Byrnes, W Gill Woodall, David B Buller, Joel W Grube, Beth Bourdeau, Brenda A Miller, Hilary F Byrnes, W Gill Woodall, David B Buller, Joel W Grube

Abstract

Background: There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation.

Objective: This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time.

Methods: A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents.

Results: Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations.

Conclusions: Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term.

Trial registration: ClinicalTrials.gov NCT03521115; https://ichgcp.net/clinical-trials-registry/NCT03521115.

Keywords: adolescent; intervention; mobile phone; parenting; randomized controlled trial; sexual behavior.

Conflict of interest statement

Conflicts of Interest: None declared.

©Beth Bourdeau, Brenda A Miller, Hilary F Byrnes, W Gill Woodall, David B Buller, Joel W Grube. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 15.06.2021.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram.
Figure 2
Figure 2
Gender by exposure over time (mean scores).

References

    1. Burgess V, Dziegielewski S, Green C. Improving comfort about sex communication between parents and their adolescents: practice-based research within a teen sexuality group. Brief Treat Crisis Interven. 2005;5(4):379–90. doi: 10.1093/brief-treatment/mhi023.
    1. Pariera KL, Brody E. “Talk More About It”: Emerging adults’ attitudes about how and when parents should talk about sex. Sex Res Soc Policy. 2017 Dec 9;15(2):219–29. doi: 10.1007/s13178-017-0314-9.
    1. Ashcraft AM, Murray PJ. Talking to parents about adolescent sexuality. Pediatr Clin North Am. 2017 Apr;64(2):305–20. doi: 10.1016/j.pcl.2016.11.002.
    1. Diiorio C, Pluhar E, Belcher L. Parent-child communication about sexuality. J HIV/AIDS Prev Edu Adol Child. 2009 Nov 13;5(3-4):7–32. doi: 10.1300/j129v05n03_02.
    1. Bleakley A, Khurana A, Hennessy M, Ellithorpe M. How patterns of learning about sexual information among adolescents are related to sexual behaviors. Perspect Sex Reprod Health. 2018 Mar 20;50(1):15–23. doi: 10.1363/psrh.12053.
    1. Coakley TM, Randolph S, Shears J, Beamon ER, Collins P, Sides T. Parent-youth communication to reduce at-risk sexual behavior: a systematic literature review. J Hum Behav Soc Environ. 2017 Apr 19;27(6):609–24. doi: 10.1080/10911359.2017.1313149.
    1. Balaji AB, Oraka E, Fasula AM, Jayne PE, Carry MG, Raiford JL. Association between parent-adolescent communication about sex-related topics and HIV testing, United States. 2006-2013. AIDS Care. 2017 Mar 04;29(3):344–9. doi: 10.1080/09540121.2016.1238443.
    1. Widman L, Choukas-Bradley S, Noar SM, Nesi J, Garrett K. Parent-adolescent sexual communication and adolescent safer sex behavior: a meta-analysis. JAMA Pediatr. 2016 Jan 01;170(1):52–61. doi: 10.1001/jamapediatrics.2015.2731.
    1. Haglund KA, Fehring RJ. The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults. J Relig Health. 2010 Dec 30;49(4):460–72. doi: 10.1007/s10943-009-9267-5.
    1. Hahm H, Lee J, Zerden L, Ozonoff A, Amodeo M, Adkins C. Longitudinal effects of perceived maternal approval on sexual behaviors of Asian and Pacific Islander (API) young adults. J Youth Adolescence. 2007 Oct 18;37(1):74–84. doi: 10.1007/s10964-007-9234-y.
    1. Negy C, Velezmoro R, Reig-Ferrer A, Smith-Castro V, Livia J. Parental influence on their adult children's sexual values: a multi-national comparison between the United States, Spain, Costa Rica, and Peru. Arch Sex Behav. 2016 Feb 22;45(2):477–89. doi: 10.1007/s10508-015-0570-9.
    1. Simons LG, Burt CH, Tambling RB. Identifying mediators of the influence of family factors on risky sexual behavior. J Child Fam Stud. 2012 Jun 3;22(4):460–70. doi: 10.1007/s10826-012-9598-9.
    1. Maria DS, Markham C, Bluethmann S, Mullen PD. Parent-based adolescent sexual health interventions and effect on communication outcomes: a systematic review and meta-analyses. Perspect Sex Reprod Health. 2015 Mar 30;47(1):37–50. doi: 10.1363/47e2415.
    1. Blake SM, Simkin L, Ledsky R, Perkins C, Calabrese JM. Effects of a parent-child communications intervention on young adolescents' risk for early onset of sexual intercourse. Fam Plan Perspect. 2001 Mar;33(2):52. doi: 10.2307/2673750.
    1. Marseille E, Mirzazadeh A, Biggs MA, Miller AP, Horvath H, Lightfoot M, Malekinejad M, Kahn JG. Effectiveness of school-based teen pregnancy prevention programs in the USA: a systematic review and meta-analysis. Prev Sci. 2018 May 27;19(4):468–89. doi: 10.1007/s11121-017-0861-6.
    1. Manlove J, Fish H, Moore KA. Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence. Adolesc Health Med Ther. 2015 Apr;:47. doi: 10.2147/ahmt.s48054.
    1. Downing J, Jones L, Bates G, Sumnall H, Bellis MA. A systematic review of parent and family-based intervention effectiveness on sexual outcomes in young people. Health Educ Res. 2011 Oct 07;26(5):808–33. doi: 10.1093/her/cyr019.
    1. Mytton J, Ingram J, Manns S, Thomas J. Facilitators and barriers to engagement in parenting programs: a qualitative systematic review. Health Educ Behav. 2014 Apr 02;41(2):127–37. doi: 10.1177/1090198113485755.
    1. Allison S, Bauermeister JA, Bull S, Lightfoot M, Mustanski B, Shegog R, Levine D. The intersection of youth, technology, and new media with sexual health: moving the research agenda forward. J Adolesc Health. 2012 Sep;51(3):207–12. doi: 10.1016/j.jadohealth.2012.06.012.
    1. Hadley W, Brown LK, Barker D, Warren J, Weddington P, Fortune T, Juzang I. Work It Out Together: Preliminary efficacy of a parent and adolescent DVD and workbook intervention on adolescent sexual and substance use attitudes and parenting behaviors. AIDS Behav. 2016 Sep 7;20(9):1961–72. doi: 10.1007/s10461-016-1418-6.
    1. Bayley JE, Brown KE. Translating group programmes into online formats: establishing the acceptability of a parents' sex and relationships communication serious game. BMC Public Health. 2015 Dec 09;15(1):1225. doi: 10.1186/s12889-015-2545-0.
    1. Gilliam M, Jagoda P, Jaworski E, Hebert LE, Lyman P, Wilson MC. “Because if we don’t talk about it, how are we going to prevent it?”: lucidity, a narrative-based digital game about sexual violence. Sex Edu. 2015 Dec 23;16(4):391–404. doi: 10.1080/14681811.2015.1123147.
    1. Wurdak M, Kuntsche E, Wolstein J. Effectiveness of an email-based intervention helping parents to enhance alcohol-related parenting skills and reduce their children’s alcohol consumption – a randomised controlled trial. Drug Educ Prev Polic. 2016 Jul 26;24(2):144–51. doi: 10.1080/09687637.2016.1201459.
    1. Pot M, Paulussen TG, Ruiter RA, Eekhout I, de Melker HE, Spoelstra ME, van Keulen HM. Effectiveness of a web-based tailored intervention with virtual assistants promoting the acceptability of HPV vaccination among mothers of invited girls: randomized controlled trial. J Med Internet Res. 2017 Sep 06;19(9):e312. doi: 10.2196/jmir.7449.
    1. Cornelius JB, Cato M, Lawrence JS, Boyer CB, Lightfoot M. Development and pretesting multimedia HIV-prevention text messages for mobile cell phone delivery. J Assoc Nurses AIDS Care. 2011 Sep;22(5):407–13. doi: 10.1016/j.jana.2010.11.007.
    1. Cornelius J, Dmochowski J, Boyer C, Lawrence JS, Lightfoot M, Moore M. Text-messaging-enhanced HIV intervention for African American adolescents: a feasibility study. J Assoc Nurses AIDS Care. 2013;24(3):256–67. doi: 10.1016/j.jana.2012.06.005.
    1. Jones K, Williams J, Sipsma H, Patil C. Adolescent and emerging adults' evaluation of a Facebook site providing sexual health education. Public Health Nurs. 2019 Jan 01;36(1):11–7. doi: 10.1111/phn.12555.
    1. Sun WH, Wong CK, Wong WC. A peer-led, social media-delivered, safer sex intervention for Chinese college students: randomized controlled trial. J Med Internet Res. 2017 Aug 09;19(8):e284. doi: 10.2196/jmir.7403.
    1. Drost RM, Paulus AT, Jander AF, Mercken L, de Vries H, Ruwaard D, Evers SM. A web-based computer-tailored alcohol prevention program for adolescents: cost-effectiveness and intersectoral costs and benefits. J Med Internet Res. 2016 Apr 21;18(4):e93. doi: 10.2196/jmir.5223.
    1. Internet/broadband fact sheet. Pew Research Center. 2021. [2020-02-28].
    1. Byrnes HF, Miller BA, Grube JW, Bourdeau B, Buller DB, Wang-Schweig M, Woodall WG. Prevention of alcohol use in older teens: a randomized trial of an online family prevention program. Psychol Addict Behav. 2019 Feb;33(1):1–14. doi: 10.1037/adb0000442.
    1. Craig BM, Hays RD, Pickard AS, Cella D, Revicki DA, Reeve BB. Comparison of US panel vendors for online surveys. J Med Internet Res. 2013 Nov 29;15(11):e260. doi: 10.2196/jmir.2903.
    1. Wang-Schweig M, Miller BA, Buller DB, Byrnes HF, Bourdeau B, Rogers V. Using panel vendors for recruitment into a web-based family prevention program: methodological considerations. Eval Health Prof. 2017 Jan 01;42(1):24–40. doi: 10.1177/0163278717742189.
    1. Bauman KE, Foshee VA, Ennett ST, Hicks K, Pemberton M. Family matters: a family-directed program designed to prevent adolescent tobacco and alcohol use. Health Promot Pract. 2001 Jun 30;2(1):81–96. doi: 10.1177/152483990100200112.
    1. Abar C, Turrisi R. How important are parents during the college years? A longitudinal perspective of indirect influences parents yield on their college teens' alcohol use. Addict Behav. 2008 Oct;33(10):1360–8. doi: 10.1016/j.addbeh.2008.06.010.
    1. Ausubel D, Montemayor R, Svajian P. Theory and Problems of Adolescent Development. New York: Grune & Stratton; 1977. pp. 1–572.
    1. Clausen JA. Socialization and Society. Boston, Massachusetts, United States: Little, Brown and Company; 1968. pp. 1–400.
    1. Foshee V, Bauman KE. Parental and peer characteristics as modifiers of the bond-behavior relationship: an elaboration of control theory. J Health Soc Behav. 1992 Mar;33(1):66. doi: 10.2307/2136858.
    1. Hirschi T. Causes of Delinquency. London, United Kingdom: Routledge; 2001. pp. 1–334.
    1. Hawkins JD, Weis JG. The social development model: an integrated approach to delinquency prevention. J Primary Prevent. 1985 Dec;6(2):73–97. doi: 10.1007/bf01325432.
    1. Brook J, Brook D, Gordon A, Whiteman M, Cohen P. The psychosocial etiology of adolescent drug use: a family interactional approach. Genet Soc Gen Psychol Monogr. 1990 May;116(2):111–267.
    1. Bandura A. Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall, Inc; 1976. pp. 1–256.
    1. Glanz K, Lewis F, Rimer B. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass; 1991. The scope of health promotion and health education; pp. 3–18.
    1. Maibach E, Parrott R. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Thousand Oaks, California, United States: Sage Publications Inc; 1995. pp. 1–320.
    1. O'Keefe D. Persuasion Theory and Research. Thousand Oaks, California, United States: Sage Publications; 1990. pp. 1–384.
    1. Turrisi R, Jaccard J, Taki R, Dunnam H, Grimes J. Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies. Psychol Addict Behav. 2001 Dec;15(4):366–72. doi: 10.1037/0893-164x.15.4.366.
    1. Teitelman AM, Loveland-Cherry CJ. Girls' perspectives on family scripts about sex-related topics and relationships. J HIV/AIDS Prev Child Youth. 2005 May 26;6(1):59–90. doi: 10.1300/j499v06n01_05.
    1. Basile KC, Rostad WL, Leemis RW, Espelage DL, Davis JP. Protective factors for sexual violence: understanding how trajectories relate to perpetration in high school. Prev Sci. 2018 Nov 27;19(8):1123–32. doi: 10.1007/s11121-018-0940-3.
    1. Dittus PJ, Michael SL, Becasen JS, Gloppen KM, McCarthy K, Guilamo-Ramos V. Parental monitoring and its associations with adolescent sexual risk behavior: a meta-analysis. Pediatrics. 2015 Dec 30;136(6):1587–99. doi: 10.1542/peds.2015-0305.
    1. Ethier KA, Harper CR, Hoo E, Dittus PJ. The longitudinal impact of perceptions of parental monitoring on adolescent initiation of sexual activity. J Adolesc Health. 2016 Nov;59(5):570–6. doi: 10.1016/j.jadohealth.2016.06.011.
    1. Cupp PK, Atwood KA, Byrnes HF, Miller BA, Fongkaew W, Chamratrithirong A, Rhucharoenpornpanich O, Rosati MJ, Chookhare W. The impact of Thai family matters on parent-adolescent sexual risk communication attitudes and behaviors. J Health Commun. 2013 Nov;18(11):1384–96. doi: 10.1080/10810730.2013.778371.
    1. Turrisi R, Abar C, Mallett K, Jaccard J. An examination of the mediational effects of cognitive and attitudinal factors of a parent intervention to reduce college drinking. J Appl Soc Psychol. 2010 Oct 01;40(10):2500–26. doi: 10.1111/j.1559-1816.2010.00668.x.
    1. Reimuller A, Hussong A, Ennett ST. The influence of alcohol-specific communication on adolescent alcohol use and alcohol-related consequences. Prev Sci. 2011 Dec 11;12(4):389–400. doi: 10.1007/s11121-011-0227-4.
    1. Madsen SD. Parents’ management of adolescents’ romantic relationships through dating rules: gender variations and correlates of relationship qualities. J Youth Adolescence. 2008 Jul 19;37(9):1044–58. doi: 10.1007/s10964-008-9313-8.
    1. Feinstein BA, Thomann M, Coventry R, Macapagal K, Mustanski B, Newcomb ME. Gay and bisexual adolescent boys' perspectives on parent-adolescent relationships and parenting practices related to teen sex and dating. Arch Sex Behav. 2018 Aug 26;47(6):1825–37. doi: 10.1007/s10508-017-1057-7.
    1. Sexual Minority Assessment Research Team Best practices for asking questions about sexual orientation on surveys. The Williams Institute of the University of California Los Angeles School of Law. 2009. [2021-05-16].
    1. Heckman JJ. Sample selection bias as a specification error. Econometrica. 1979 Jan;47(1):153. doi: 10.2307/1912352.
    1. Certo ST, Busenbark JR, Woo H, Semadeni M. Sample selection bias and Heckman models in strategic management research. Strat Mgmt J. 2016 Feb 09;37(13):2639–57. doi: 10.1002/smj.2475.
    1. Tucker JW. Selection bias and econometric remedies in accounting and finance research. J Account Lit. 2010. [2021-05-16]. .
    1. Gross D, Fogg L. A critical analysis of the intent-to-treat principle in prevention research. J Prim Prev. 2004 Dec;25(4):475–89. doi: 10.1023/b:jopp.0000048113.77939.44.
    1. Coie JD, Watt NF, West SG, Hawkins JD, Asarnow JR, Markman HJ, Ramey SL, Shure MB, Long B. The science of prevention: a conceptual framework and some directions for a national research program. Am Psychol. 1993;48(10):1013–22. doi: 10.1037/0003-066x.48.10.1013.
    1. Titus MA. Detecting selection bias, using propensity score matching, and estimating treatment effects: an application to the private returns to a master’s degree. Res High Educ. 2006 Aug 19;48(4):487–521. doi: 10.1007/s11162-006-9034-3.

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