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Boys’ Health Risks May Be Reduced by Strengthening Father-Son Bonds

Addresses CDC Winnable Battle: Tobacco, Obesity, Motor vehicle injuries, Teen pregnancy, HIV prevention  

Fathers and Sons Program

Study results suggest improved communication between fathers and sons and increased healthy behaviors among adolescents

Large-scale replication study is in planning stages


Many African-American boys grow up in single-parent households, a situation that limits their chance of building a meaningful relationship with their biological fathers. The lack of a positive father-son relationship is believed to contribute to violent behavior among adolescents, early sexual encounters, substance abuse, and poor academic achievement—all of which may compromise individual and family short- and long-term health and well-being.


Flint, Michigan, an economically disadvantaged community in which the prevalence of adolescent risk behaviors is high, was chosen by the Prevention Research Center (PRC) of Michigan as an intervention site. The PRC offered academic strength as well as concern and commitment to collaborate with the Genesee County Health Department, community-based organizations, and other community representatives in addressing the health risks of young males. The community expressed concern about adolescent violence and was interested in finding ways to reduce substance abuse and early sexual behavior as well as in increasing healthy behavior among its adolescent residents.

Methods & Results

Using a community-based participatory process, a steering committee composed of PRC researchers and community representatives systematically explored potential positive ways to affect preadolescent African-American males living apart from their biological fathers. Eight focus groups (77 participants) were conducted to gather information to guide intervention development, and relevant findings from the scientific literature were reviewed. Based on these sources of information, the steering committee chose to focus on 8- to 12-year-old boys and their nonresident fathers through a program centered on effective communication, cultural awareness, and skill building. The program combined several behavioral theories to guide program development: Theory of Reasoned Action, Social Cognitive Theory, Social Networks and Social Support, and Models of Racial Identity and Race-related Socialization.

This study used a quasi-experimental pre- and post-test design to evaluate intervention effectiveness. Nonresident fathers and their sons were recruited from Flint, Michigan, to participate in the intervention; nonresident fathers and sons from Saginaw, Michigan, a city with similar demographic characteristics, were recruited to serve as a comparison group. The same pre- and post-test were administered to both groups.

The intervention was designed to provide the researchers both qualitative and quantitative outcome and process data for evaluation. The intervention consisted of 15 sessions, each 2 to 3 hours, held twice per week during a 2-month period. The sessions provided information, discussion time, and opportunities for role reversal exercises and for practicing skills, such as refusing drugs from peers (for sons) and specific parenting behaviors (for fathers). In addition, boys and their fathers worked on homework assignments together and attended about four hours of community activities together. Eligible participants in the intervention group included 185 father-son pairs, 85% (158) of which completed the program. A total of 186 eligible father-son pairs were identified for the comparison group; 165 (89%) completed the pretest and 129 (69%) completed the posttest. The fathers in the intervention group had an average age of 37 years; 53% reported having insufficient or barely enough money to get by, and 48% were unemployed. The boys were an average age of 10 years. Fathers and sons in the comparison group were comparable in these characteristics. Results from analyses of the intervention indicated that it was successful in influencing several factors thought to help prevent health risk behaviors in youth. Especially promising were findings that suggested that nonresident African-American fathers can improve their parenting behaviors related to discipline and monitoring their sons’ activities as well as communication about sex. The intervention was also beneficial for sons, who reported increased monitoring by their fathers, improved communication about sex, and increased intentions to avoid violence. The intervention was not effective in reducing aggressive behaviors among the sons.

Consequences And Potential Impact

The researchers’ initial goal was to have a limited dissemination of the Fathers and Sons Program during the formal evaluation period to determine how effectively aspects of the program could be implemented by community-based organizations not affiliated with the project. Based on evaluation analyses, plans for a large effectiveness trial were made. Using funding from the Ford Foundation, the PRC worked in collaboration with Columbia University's School of Social Welfare and Public Policy to develop a strategy for testing the effectiveness of the program in several geographic areas. Four sites were selected for replicating the project: Saginaw, Michigan; New Haven, Connecticut; New York, New York; and Baltimore, Maryland. The effectiveness trial will use an experimental study design—fathers and sons in the intervention groups will receive a curriculum that has been revised to focus more on parenting and father-son communication; fathers and sons in the control groups will spend comparable time together as the intervention group but will focus on recreational activities. Researchers hope to clarify subgroups for which the program may be most effective and whether the intervention is influenced by different social contexts, such as geographic location or community size. Future tests will also determine the long-term effects of this promising intervention.

Participants who graduated from the original Fathers and Sons Program reported that the intervention was of value to them, and they continued as a support group for two years after the official program ended. Further data analyses from the original intervention have shown that nonresident African-American fathers who are depressed are not able to monitor their sons as well as those who are not and that influencing the fathers’ parenting behaviors is associated with positive outcomes for sons.


Caldwell CH, Rafferty J, Reischl TM, De Loney EH, Brooks CL. Enhancing Parenting Skills Among Nonresident African American Fathers as a Strategy for Preventing Youth Risky Behaviors. American Journal of Community Psychology March 2010;45(1-2):17-35.

Caldwell CH, Rafferty J, De Loney EH, Reischl TM. The Flint Fathers and Sons Program. Practice Notes: Strategies in Health Education, Health Education & Behavior 2008;35:155–57.

Caldwell CH, De Loney EH, Mincy R, Klempin S, Brooks CL, Rafferty J. (In Press). Strengthening bonds between nonresident African American fathers and sons as a way to reduce or prevent youth risky behaviors. In: Craig Haen (Ed.), Creative Approaches for Engaging Boys in Treatment, Routledge Book Series on Counseling and Psychotherapy with Boys and Men. New York: Routledge Publishers.

Caldwell CH, Wright JC, Zimmerman MA, Walsemann KM, Williams D, Isichei PA. Enhancing adolescent health behaviors through strengthening non-resident father-son relationships: a model for intervention with African American families. Health Education Research: Theory and Practice 2004;19:644–56.

Caldwell CH, Zimmerman MA, Isichei PA. Forging collaborative partnerships to enhance family health: an assessment of strengths and challenges in doing community-based research. Journal of Public Health Management Practice 2001;7:1–9.

Davis RN, Caldwell CH, Clark SJ, Davis M. Depressive symptoms in non-resident African American fathers and involvement with their sons. Pediatrics 2009 Dec:124(6):1611-8.

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