No. 4, October 2006
Talking Parents, Healthy Teens: A Worksite-based Program for Parents to
Promote Adolescent Sexual Health
Karen L. Eastman, PhD, Rosalie Corona, PhD, Mark A. Schuster, MD, PhD
Suggested citation for this article: Eastman KL, Corona R, Schuster
MA. Talking Parents, Healthy Teens: a worksite-based program for parents to
promote adolescent sexual health. Prev Chronic Dis [serial online] 2006 Oct [date
cited]. Available from: http://www.cdc.gov/pcd/issues/2006/
Parents play an important role in the sexual health of their adolescent
children. Based on previous research, formative research, and theories of
behavioral change, we developed Talking Parents, Healthy Teens, an
intervention designed to help parents improve communication with their
adolescent children, promote healthy adolescent sexual development, and reduce
adolescent sexual risk behaviors. We conduct the parenting program
at worksites to facilitate recruitment and
retention of participants. The program consists of 8 weekly 1-hour sessions
during the lunch hour.
In this article, we review the literature that identifies parental influences
on adolescent sexual behavior, summarize our formative research, present
the theoretical framework we used to develop Talking Parents, Healthy Teens,
describe the program’s components and intervention strategies, and offer
recommendations based on our experiences developing the program. By targeting
parents at their worksites, this program represents an innovative approach to
promoting adolescent sexual health. This article is intended to be helpful to health educators and
clinicians designing programs for parents, employers implementing
health-related programs, and researchers who may consider designing and
evaluating such worksite-based programs.
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As documented by the Centers for Disease Control and Prevention’s (CDC’s)
Youth Risk Behavior Survey (YRBS), many adolescents engage in
behaviors that increase their risk of sexually transmitted diseases (STDs) and
unintended pregnancies (1). Most efforts to promote healthy adolescent sexual
development and reduce risk have targeted adolescents through community- or
school-based programs (2-5). There has been much less focus on the protective
role parents can play in raising sexually healthy adolescents.
We developed Talking Parents, Healthy Teens, a program to help parents
learn parenting and communication skills that would facilitate communication
with their adolescent children, promote healthy adolescent sexual behaviors,
and reduce sexual risk behaviors. The program is provided at worksites as a
means of reaching a large number of parents easily.
In this article, we briefly review the role that parents can play in
adolescent sexual health, present the theoretical framework used to develop
Talking Parents, Healthy Teens,
and describe the program’s components and intervention strategies.
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Certain parenting behaviors and types of parent–adolescent relationships are related to
adolescent risk behaviors. For example, adolescents whose parents monitor them
are more likely than others to initiate intercourse at later ages (6-8) and to
have fewer partners and use condoms if they are sexually active (9-12). The
more involved parents are with their adolescents (e.g., knowledgeable about
their school and extracurricular activities), the less likely their
adolescents will be to initiate sex at earlier ages and to engage in drug use
and other problem behaviors (13-15). In addition, adolescents are less likely
to initiate intercourse at a young age or engage in frequent intercourse, and
more likely to use contraception, if they are positively connected to their
parents (e.g., feel satisfied in their relationships) (16-18).
Although older studies on the relationship between parent–adolescent
communication and adolescent sexual behavior have shown mixed results (19-21),
some researchers have found that when parents talk to their adolescents about
sexuality, adolescents are more likely to delay intercourse and if they have
intercourse, to use contraception and have fewer partners (22-24). Yet, many
parents do not feel comfortable talking with their adolescents about sexual
topics (25); when parents talk about these topics, they tend to lecture (26), possibly inhibiting open communication. Parents who feel more
confident in their parent–adolescent communication skills are more likely
than less confident parents to engage in conversations about sex (27-29). In
addition, parents’ use of open-ended questions is positively associated with
adolescent engagement in conversations about sexuality (30).
Despite the evidence for the protective role of parents in adolescent
sexual health, most HIV and sex education programs targeted at teens have no
role or a limited role for parents (4). Although these programs are an
important component of health promotion efforts for youth, their effects often
extinguish fairly rapidly. By contrast, programs that help parents influence their adolescents’ behaviors may have
more enduring effects. Parents generally have more contact than most other
adults with their adolescents, are familiar with their adolescents’
attitudes and idiosyncrasies (or could be), and are invested in their children’s
lives. Given parents’ long-term perspective on the implications of their
adolescents’ sexual health and development and their ability to retain and
use knowledge and skills, parents have the potential to provide the ongoing
reinforcement that time-limited youth programs can rarely offer. As a result,
there has been a push to develop parent-only programs (31-33), but few have
actually been evaluated (26,34,35), and others are undergoing evaluation
(36). Our program adds to this growing number of parenting programs but is
unique in that it is the only such program that we know of that is delivered at a parent’s
workplace and is undergoing rigorous evaluation in a randomized controlled
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The worksite setting
Interventions aimed at parents need to reach and engage them. This can be
difficult in community settings where many parents must make a special effort
to attend (37). Parent training programs on various topics generally have high
dropout rates, ranging from about 25% to more than 40% (38,39). A
promising alternative is to bring the intervention to parents where they work,
an approach that may facilitate recruitment and retention (40). Worksite-based
health programs, such as weight reduction (41) and smoking cessation (42),
have been successful in changing employees’ health-related behaviors. Although
some employers have programs to help employees with family issues, few have
programs designed to address the needs of parents of adolescents. Talking
Parents, Healthy Teens addresses this gap.
Additional advantages of the worksite setting include having the support of
the workplace management, which can serve as a form of “approval” that
makes the parenting program more inviting to employees. Finally, worksites may
provide an infrastructure that makes them an easier setting than others for
implementing Talking Parents, Healthy Teens or similar programs.
Formative research: curriculum development
In developing the parenting program, we 1) reviewed and adapted curricula of parenting
programs (general programs and programs covering parent–adolescent
communication) and adolescent programs; 2) consulted with researchers and
educators with expertise in adolescent behavior, parenting, health promotion,
and adult learning principles; 3) conducted focus groups with parents and
adolescents and interviews with worksite representatives (43); and 4) piloted
the program at three worksites and then revised it based on our
In 1991, the leading proponents of behavior change theories dominating
HIV-related research (e.g., social learning theory, health belief model,
theory of reasoned action) came to consensus on the eight variables that most
strongly influence behavior change (44). They identified three factors as
necessary and sufficient: 1) an individual’s skills or ability to
engage in behavior; 2) an individual’s intentions to engage in
behavior; and 3) the absence of environmental barriers that prevent
behavior or the presence of resources (facilitators) to engage in
behavior. Five additional factors have both a direct and an indirect effect on
behavior by influencing intentions: 4) perceived self-efficacy; 5) perceived
social norms; 6) perceived net benefits; 7) perceived consistency with
personal standards (i.e., behavior is consistent with self-image); and 8)
emotional response (i.e., emotional reaction to behavior is more positive than
negative). Knowledge and beliefs also influence these five factors.
We applied these eight factors to Talking Parents, Healthy Teens (Figure)
and hypothesized that parents would change their parenting behaviors, which
would lead to a change in adolescent behaviors. Talking Parents, Healthy Teens
aims to influence parents’ skills such as communication, monitoring,
and involvement; intentions to talk about sex, monitor, and stay
involved; and perceptions of environmental barriers and facilitators
that influence talking about sexuality (e.g., community norms that discourage
or encourage such communication). By increasing parents’ skills and
facilitating opportunities for communication through take-home activities, the
program also aims to affect the parent–adolescent relationship, further
influencing adolescent behavior change (e.g., the likelihood that adolescents
will delay intercourse or use condoms).
Figure. Theoretical model of the relationship between parent–adolescent
interactions and adolescent behaviors for the Talking Parents, Healthy Teens
program. [A text description of this model is also available.]
Other examples illustrate the types of interactions captured by the
- Parents learn communication skills (e.g., encouraging youth to express
their feelings and thoughts) aimed at strengthening their relationships with their children.
They also learn communication skills they can teach their children to use
in peer and romantic relationships (e.g., assertiveness skills such as how to say
no to undesired activities). Parents learn how to improve the parent–adolescent
relationship and build on that relationship to teach the child skills
that influence behavioral outcomes.
- Parents can monitor adolescents more effectively (e.g., calling home
during the afternoon after the child returns from school or
arranging for an adult to be home). Parental monitoring can influence
adolescent outcomes through the parent–child relationship.
- Improving parent–adolescent communication (e.g., talking about
pregnancy prevention) may affect child factors (e.g., ability to negotiate
condom use) that influence an adolescent’s intentions (e.g., to
use condoms) and subsequent behaviors (e.g., condom use). The quality of
the parent–adolescent relationship may influence how an adolescent
responds to a parent’s belief about appropriate sexual behavior. For
example, if the parent and adolescent have a distant relationship, the
child may be more likely to dismiss the parent’s view; if the
relationship is close, the parent’s opinion may influence the adolescent’s
intentions and behaviors.
- Parents’ feelings of self-efficacy and emotional responses may influence
their intentions and consequently their communication with their adolescents
about sex. For example, parents may feel more competent to talk about sex
and therefore more positive about having conversations about sex, which can
lead to more frequent and effective communication with their adolescents.
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Program Description: Key Features
Talking Parents, Healthy Teens is a parenting program for parents of sixth
to tenth graders. It consists of eight weekly 1-hour sessions presented during
the lunch hour to groups of about 15 parents. A trained facilitator and
assistant facilitator lead the program using a standardized, scripted, program
manual. We provide lunch, which serves as an incentive for participation and
reduces late arrivals. The program is interactive and focuses on building
parents’ abilities, comfort, and confidence; lecturing is minimal. Sessions
focus on skill-building and practice. Each session builds on previous ones;
the facilitator reviews the prior week’s lessons and troubleshoots issues that arose when parents used new skills at home. We mail materials to parents
who miss sessions (usually through interoffice mail at the worksite), and the
facilitator reviews the session content with absent parents by telephone.
Diversity of participant values and comfort discussing sex
The program acknowledges that parents have diverse experiences and
backgrounds; values, and moral and religious beliefs; and levels of comfort
addressing sex-related topics. It is designed so that parents can apply what
they learn to achieve their goals. We teach skills, facts, and options and offer
advice for how and when to talk to children, but we do not dictate to parents
what they should do or how they should feel. For example, to provide
balance for parents with diverse views, the same session covers how to say no to
sex and how to use a condom. We have had favorable feedback from parents
who want their children to refrain from sex until marriage and parents who are
comfortable with their high-school-aged adolescents having sex (with
Communication skills are a major program feature. For example, parents
learn how to start and sustain conversations on sensitive sex-related topics,
how to ask questions, and how to listen without lecturing. After parents learn
basic communication skills, they learn skills that they can teach their
children. The facilitator reviews the elements of each skill and provides
examples illustrating its use and benefits. Volunteers read aloud parent–child
dialogues that use (or fail to use) the skill, and then all parents practice
the skill in role-plays.
Between sessions 4 and 7, parents meet individually with the facilitators for a
private session to practice the skills and receive feedback. The parent and one of
the facilitators, who plays the role of the adolescent based on the parent’s
description of his or her child, engage in a role-play about a sex-related
topic. The role-play is videotaped so that the facilitators can review it with
the parent. Parents observe their tone, word choice, and body language in what
can be an eye-opening exercise. They then develop a plan to improve their
Each week, parents receive a set of short activities to help them practice
new skills at home. Some exercises help parents think about important issues
related to their adolescents (e.g., appropriate supervision), and some help
parents communicate with adolescents by providing games to play and
sex-related topics to discuss (Table).
Parents receive the following handouts during the program: 1) facts of
life, which cover topics such as puberty, contraception, HIV and
other STDs, sexual orientation, and alcohol use; 2) communication skills, which summarize communication skills taught during the sessions; 3) parenting
tips, which provide additional examples of parenting strategies;
4) worksheets, which are used for in-class exercises that help parents learn
program material; 5) key ring cards — short outlines of communication skills
printed on small laminated cards and attached to a key ring — used so that
parents can keep skill summaries handy; and 6) a parenting resource list that
hotlines, books, and other resources. Parents also receive a participant
notebook in which to keep handouts and notes.
Raffles with prizes (e.g., a teen sexual health book) are held during the
program. At the end of the program, parents receive a certificate for course
completion that provides a marker of their accomplishment and encourages
continued work on parent–child relationships.
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Summary of Sessions
Session 1: Building your relationship with your child
Overview. Session 1 provides an overview of the program and reasons
for offering it. The session focuses on positive parent–child relationships,
covering points that are reinforced in later sessions: the importance of 1)
talking to children about sex; 2) establishing a quality parent–child
relationship; 3) identifying and reinforcing children’s strengths; 4)
spending time with children; 5) helping children develop future goals; and 6)
Communication skills. Parents are encouraged to praise or
reinforce their children’s strengths by “catching their child doing something
good” (i.e., noticing a positive behavior and making a favorable comment to
the child about it).
Session 2: Your adolescent’s development and new ways of communicating
Overview. Session 2 focuses on the importance of being involved in
the adolescent’s life and reinforces positive parent–adolescent
relationships. By discussing adolescent physical, social, emotional, and
cognitive development, parents learn that some adolescent behaviors that are
baffling and frustrating may be a normal part of development. They are
reminded of how physical changes may affect the way adolescents feel about
themselves and that an adolescent’s sexual and romantic feelings are
developing. The topic of sexual orientation is introduced.
Communication skills. Parents are introduced to two skills. 1) “I” messages are statements parents make that include the phrase, “I
feel. . . .” For example, “When you play your music loudly, I feel annoyed
because I can’t get my work done.” These messages do not label or blame
the adolescent; they focus on the parent’s feelings and not on the
adolescent’s misbehavior. “I” messages can reduce the likelihood that
conflict will escalate. 2) Strategies for inviting children to talk
(e.g., offering several examples of what a person might feel in a given
situation to help adolescents identify and discuss their own feelings) can
increase the likelihood of general conversation and may be particularly
helpful to parents whose children frequently give responses like “uh huh.”
The program reinforces the value of having general, nonspecific conversations
with adolescents in addition to engaging in specific conversations about sex.
The facilitator addresses parents’ inability to make children talk if they
do not want to and the value of spending time together engaged in activities.
Session 3: Listening skills for talking about sensitive topics
Overview. Session 3 focuses on listening to adolescents and
addresses parents’ concerns about talking about sex. Parents identify and
discuss reasons why they might be reluctant to talk with their children about
sex (e.g., fear that talking about sex might encourage it, that the child is
too young to talk about it, that they might disclose more about their own past
than they want to). By addressing these concerns, parents develop the
confidence to talk to their children about sex.
Communication skills. Parents learn an approach called active
listening, which involves paying attention, listening without
interrupting, restating what they have heard their children say (to confirm they
understood correctly and to show they were listening), and identifying the
feelings their children are expressing. Active listening shows youth that parents
are interested, encourages youth to express themselves, and helps them
identify their own thoughts and feelings. In conversations about sex, this
communication skill increases the likelihood that parents and adolescents will
engage in a balanced discussion instead of an intervention in which the parents
lecture and the adolescents say little.
Session 4: Talking about sex: getting past roadblocks
Overview. In Session 4, the program moves from skills that promote
general communication and positive parent–child relationships to skills that
support communication specifically about sex. Although many parents have a
vague feeling that they do not want their child to have sex, they may not
have identified their specific beliefs or considered how they feel about
dating and sexual behaviors that might occur before or instead of intercourse.
Identifying their beliefs helps parents consider what messages they want to
Communication skills. Parents are introduced to four strategies to
initiate conversations about sex: 1) using teachable moments (i.e., everyday
situations, such as watching a movie with a love scene, that provide
opportunities to start discussions); 2) thinking of opening lines to start the
conversation; 3) identifying roadblocks (e.g., what adolescents say to make it
hard to talk about sex) and strategies such as open-ended questions to get past them;
and 4) identifying reasons they want to talk about sex with their children and
learning how to avoid lecturing. By practicing how to start conversations
through role-plays, parents gain experience and confidence
so they can talk to their children more easily.
Session 5: Helping your child make decisions
Overview. Session 5 focuses on developing abilities to engage in
longer conversations about sex-related topics with adolescents. Parents think
about the reasons that adolescents might and might not want to have sex. By
considering the adolescent perspective on sexual matters, parents can
anticipate potential adolescent responses and work to make their discussions
Communication skills. Parents are presented with reasons why it is
important to help children learn how to make their own healthy decisions about
sexual behavior rather than dictating to them what to do. Parents are
introduced to decision-making skills that involve the parent asking the
adolescent questions to help the adolescent develop decision-making skills. These decision-making skills are called the S.T.O.P.
steps: State the decision; Talk about feelings and needs;
brainstorm and discuss Options; and Pick the best option and
later evaluate it.
Session 6: Assertiveness skills, abstinence, and contraception
Overview. The first part of Session 6 covers assertiveness skills
for adolescents who want to remain abstinent from sexual activity in general
or refrain from some or all sexual activities in a particular situation. The second part
of the session addresses various methods of preventing STDs or unintended
pregnancies among adolescents who engage in sexual activity. Parents discuss
advantages and disadvantages of condoms and how they would talk to their
children about them. The facilitator demonstrates how to use a condom by
putting it on two fingers, and parents have the opportunity to practice how
they would teach their adolescents the steps for correct condom use.
Communication skills. Parents learn assertiveness skills so that
they can teach them to their children: how to say no to someone who is
applying pressure in an unwanted sexual situation; how to suggest an
alternative activity as a means of getting out of a pressured situation
without implying a desire to end the relationship (e.g., proposing to go to
the movies instead); and delay tactics or methods of cooling down a pressure
situation (e.g., going to the restroom). Not only do parents engage in role-plays
in which they practice responding to someone who is pressuring them, but they
encouraged to use these role-plays at home with their adolescents.
Session 7: More assertiveness skills, coping with conflict, and supervising your kids
Overview. Session 7 addresses strategies for negotiating conflict.
Parents learn additional assertiveness skills that adolescents can use if they
decide to have sex and want to use contraception. Parents review the program
skills that can be used to cope with conflict. For example, they are shown how
the S.T.O.P. steps from session 5 can be used to resolve problems and reduce
conflict with others. Parents also discuss their supervision practices and how
to supervise their children appropriately in various situations. Finally,
parents discuss what it means to “respect others” and how they can help
their children understand concepts such as “no means no.”
Communication skills. Additional assertiveness strategies
that parents learn to teach adolescents include stating that they want to use a
condom, giving a reason why they want to use a condom, coming up with a
response that they can use if pressured to have sex without a condom, saying
no to sex without a condom, and using alternative actions and delay tactics.
Session 8: Putting it all together and staying motivated
Session 8 reviews the communication and parenting skills learned in the
prior seven sessions, motivates parents to continue using these skills, and
acknowledges parents’ efforts and participation. Parents have the opportunity
to practice all of the skills they have learned during the program in a
variety of role-plays. They are encouraged to stay in touch with and support
each other, to remember to “catch themselves doing something good,” and to
identify the next conversation they intend to have with their child about sex
or sexuality. Finally, rewards for perfect attendance and certificates of
participation are distributed. Parents also receive the
parenting resource list.
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We are currently conducting a randomized controlled trial of Talking
Parents, Healthy Teens, with randomization at the individual parent level.
Thirteen worksites in southern California are participating in the
evaluation. Worksites include for-profit businesses, nonprofit organizations,
and public agencies. The program has been provided to 20 groups of parents,
and we are collecting follow-up data. Median attendance was seven
out of eight sessions. Feedback has been quite favorable. For example,
on a postintervention survey, 96% of participants reported that they would definitely (72%) or
probably (24%) recommend the program to a friend or coworker.
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Discussion and Conclusions
Talking Parents, Healthy Teens is a promising approach for improving
parenting and communication skills as a means of promoting healthy adolescent
sexual development and reducing sexual risk behaviors. Based on theories of
behavioral change, Talking Parents, Healthy Teens teaches parenting and
communication skills that research suggests are effective. It also
includes features characteristic of successful sexual health and HIV
prevention programs. Although there
seem to be few parenting programs that focus on adolescent sexual health, even
fewer have been rigorously evaluated. We are currently evaluating Talking
Parents, Healthy Teens’ effects on parents and their adolescents.
Our experiences developing this program suggest that 1) parents
provide a unique avenue for reaching adolescents; 2) activities and strategies based on adult learning principles
can be used to teach parenting and communication skills needed to
address many of the challenges parents face in talking to their children about
sex; 3) these teaching strategies can engage groups of adults
who have various learning styles and parenting and communication abilities; and
4) programs can be designed that are acceptable to parents with diverse values
and backgrounds. We recommend that health educators, researchers, and other
professionals further explore ways to work with parents to improve the
parent–child relationship and to influence adolescents’ behavior.
Finally, our preliminary experiences conducting Talking Parents, Healthy
Teens at worksites suggest that 1) the worksite setting makes attendance more
convenient for many parents of adolescents; and 2) innovative and successful
collaborations can occur between clinicians or researchers who are addressing
adolescent sexual health and worksite personnel dedicated to improving their
employees’ family health. We recommend further development of worksite-based
programs to address such family issues as adolescent health promotion.
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The authors thank Hena T. Borneo, BA, Lisa K.
Carlstrom, PhD, Lisa K. Comer, PhD, Phyllis L. Ellickson, PhD, Jonathan E. Fielding, MD, MPH, MBA, Regina
R. Graham, MD, Martin Y. Iguchi, PhD, David E. Kanouse, PhD, Shelley D. Kilpatrick, PhD, Marguerita
Lightfoot, PhD, Robin M. Lombard, PharmD, Garth D. Meckler, MD, MSHS, Robert
E. Morris, MD, Sydne J. Newberry, PhD, Michal
Perlman, PhD, Mary Jane Rotheram-Borus, PhD, Carole Viers, MA, Avra L.
Warsofsky, MS, Gail L. Zellman, PhD, and Kimberly Zirkle, MA; other members of the UCLA/RAND Center
for Adolescent Health Promotion; members of the Center’s Community
Advisory Board; and participants in our pilot tests for their guidance and
assistance in developing the curriculum. We also thank Colleen M. Carey, BA,
and Deborah G. Perlman, BA, for help with manuscript preparation and
This project was supported by grant RO1 MH61202 from the National Institute of
Mental Health and cooperative agreements U48/CCU915773 and U48/DP000056 from
the Centers for Disease Control and Prevention.
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Corresponding Author: Mark A. Schuster, UCLA/RAND Center for Adolescent
Health Promotion, 1072 Gayley Ave, Los Angeles, CA 90024. Telephone:
310-393-0411, ext 7217. E-mail: firstname.lastname@example.org.
Dr Schuster is also
affiliated with the Department of Pediatrics, David Geffen School of Medicine
at UCLA, Los Angeles, Calif, the Department of Health Services, UCLA School of
Public Health, Los Angeles, Calif, and RAND, Santa Monica, Calif.
Author Affiliations: Karen L. Eastman, Department of Pediatrics, David
Geffen School of Medicine at UCLA, Los Angeles, Calif; Rosalie Corona,
Department of Pediatrics, David Geffen School of Medicine at UCLA and Virginia
Commonwealth University, Richmond, Va.
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