ORIGINAL RESEARCH
Breaking the ice! Predictors about communication between nonresident African American fathers and sons about sex Jade C. Burns, MSN, RN, CPNP-PC (PhD Candidate)1 & Cleopatra H. Caldwell, PhD (Professor)2 1
School of Nursing, University of Michigan, Ann Arbor, Michigan Department of Health Behavior & Health Education, Center for Research on Ethnicity, Culture & Health, School of Public Health, University of Michigan, Ann Arbor, Michigan
2
Keywords African American; parenting; adolescents; sexual health. Correspondence Jade C. Burns, MSN, RN, CPNP-PC, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109. Tel: 734-647-3176; Fax: 734-763-7379; E-mail: [email protected] Received: 7 May 2014; accepted: 16 February 2015 doi: 10.1002/2327-6924.12252 Disclosure This material has been presented at several conferences previously. All authors have contributed extensively to the work presented in this article. Jade Burns prepared the manuscript, including data analysis and interpretation. Dr. Cleopatra Caldwell, principal investigator for the Fathers and Son’s project, provided (a) data set for the development of the research topic; (2) guided analysis, interpretation; and (3) critical revision and final approval of the manuscript. The authors declare that there is no conflict of interest.
Abstract Background and purpose: Research on communication between resident and nonresident African American fathers and their sons about sex has been understudied. The purpose of this study is to determine the influence of parenting variables, specifically, racial socialization and father involvement on nonresident African American father–son communication about sex. Methods: Data for this study are from the Fathers and Sons Project. This intervention study is designed to enhance relationships between nonresident African American fathers and their 8–12 year old sons and to prevent risky health behaviors among sons. The present study is based on 345 African American boys who completed baseline face-to-face interviews. The average age of the sons was 10.2 years old (SD = 1.4), with an average of two siblings (SD = 1.53). Results: Age and sons’ perceptions of more parental monitoring by their fathers were predictive of increased communication about sex. Racial socialization messages explained additional variance in communication about sex above other parenting variables and controls. Implications for practice: Findings suggest when working with African American families, providers who counsel parents, and in particular provide outreach to fathers regarding communication about sex, are in a unique position to enhance parenting communication skills about sexuality.
Risky sexual activity is a major concern in the United States. The efforts to decrease risky sexual behavior have been supported by national reports such as Healthy People 2020 and the Youth Risk Behavior Surveillance System (YRBSS). African American adolescent males (AAAMs) engage in risky sexual behaviors and have higher rates of early sexual debut than adolescents of other race and gender subgroups, often initiating sex prior to the age of 13 (Bakken & Winter, 2002; Fergus, Zimmerman, & Caldwell, 2007; Rutledge & Boyd, 2010). AAAMs also are disproportionately affected by sexually transmitted infections (STIs). Park and Breland (2007) reported that the majority (55%) of new HIV infections occurred in AAAMs ages 13–24. Moreover, AAAMs are screened less frequently, have
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more underreported STIs, and use healthcare resources less often than adolescent females (Collins & Champion, 2009). Despite the attention of public health agencies and others to create programs to reduce or prevent risky sexual behaviors, few programs have been designed solely for adolescent males and even fewer for AAAMs. According to a study based on the National Survey of Adolescent Males (NSAM), some reasons may include difficulty in recruiting and lack of health data collected on adolescent male sexual behavior (Dariotis, Sifakis, Astone, Pleck, & Sonenstein, 2011). Thus, it is evident that more studies are needed on the sexual health needs of AAAMs. Consistent findings have suggested that knowledge alone is not associated with health behavior change in
Journal of the American Association of Nurse Practitioners 28 (2016) 84–90 C 2015 American Association of Nurse Practitioners
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interventions designed to prevent or reduce adolescent risky sexual behavior (Lehr, Demi, Dilorio, & Facteau, 2005). It is well established that discussions between parent and child are one of the best protectors in reducing risky sexual behaviors and early sexual initiation in youth (Clawson & Reese-Weber, 2003; Lehr et al., 2005; Leland & Barth, 1993; Wright, 2009). Additionally, the literature indicates that within the family, mothers are the main communicators for sex education (Hutchinson, Jemmott, Jemmott, Braverman, & Fong, 2003; Lehr et al., 2005; Ohalete, 2007; Wright, 2009). Although parents can educate their children about sex and influence their sexual decision making, much of this literature has not critically examined sexual communication with African Americans or attempted to understand the role of culture in these discussions. Further, the influence of the involvement and discussion between fathers and their children about sex are not often examined. Thus, the purpose of this study was to determine the influence of race socialization and father involvement on communication between African American boys and their nonresident fathers about sex. The results of this study may be useful in clinical practice when working with fathers to help them become more effective in their communication skills about sex with their sons.
Review of the literature Parent–adolescent communication about sex Research has demonstrated that parental communication about sex has been associated with less sexual behavior and later sexual initiation among youth regardless of race or gender (Wright, 2009; Wyckoff et al., 2007). Parents have the ability to teach preventative strategies to their children, which can improve the reduction of risky behaviors associated with early sexual initiation such as substance abuse and tobacco use. Parents also reduce the likelihood that their adolescents will engage in such risky behaviors through relational warmth, connectedness, and through parental monitoring of their children’s activities (Wright, 2009). Studies also have shown that there are wide ranges of predictive factors that relate to parent–child communication about sexual issues. Factors such as family openness and general communication have been found to influence discussions about sex (Lehr et al., 2005), with repetition of sexual topics discussed creating a comfortable and open environment in which a wide range of sexual topics are discussed (Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010; Martino, Elliot, Corona, Kanouse, & Schuster, 2008). Dilorio, McCarty, and Denzmore (2006) found that self-efficacy and outcome expectations related to talking about sexual issues were high in father–son communication.
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Gender and pubertal development influence the timing of discussions between parent and child, with parents talking with daughters more than sons and with older rather than younger children (Lehr et al., 2005; Ohalete, 2007; Wright, 2009). Parenting style, frequency of conversations, current relationship between parent and child, and cultural norms also influence these conversations (Hutchinson & Montgomery, 2007). Other family and individual factors that link to a delay in sexual debut, including religious affiliation, self-esteem, higher grade point average, increased levels of family connectedness, parental support, perceived parental disapproval, and monitoring, were also found to delay sexual debut (Caldwell, Rafferty, De Loney, & Brooks, 2010; Ohalete, 2007). These factors are critical to consider when assessing parent–child communication about sex because they represent explanatory motivations as to why parents may or may not discuss sexual issues with their children. Although discussions of sexual topics usually occur during adolescence, previous studies have indicated that preadolescence may be the best time to discuss sexual health from a prevention perspective (Wyckoff et al., 2007). Preadolescence occurs by the time a child reaches the age of 8 and is marked by the onset of pubertal changes (Burns, Dunn, Brady, Starr, & Blosser, 2009). At this age, children begin to understand sexuality and the changes that occur within their bodies (Burns et al., 2008). Preadolescents are also at a cognitive stage where they can internalize the messages that their parents are conveying about sex in age appropriate ways (Wright, 2009). Children at this age are curious and have an increased sexual awareness; therefore, preadolescence provides the perfect time to discuss topics related to sexual behavior. Ideally, messages regarding sexual behavior should be transmitted before the onset of sexual risk behaviors occurs. It is vital to reach children at an early age so they can make informed sexual decisions based on family values as they mature into adolescence. This should occur before peers or media have an influence on their opinions and sexual decision-making processes.
African American fathers and sexual communication More studies of the influence of nonresidential fathers on their children have emerged in the literature in recent years. A nonresident father is one who does not live in the same home as his child and may be separated, divorced, or never married to the child’s mother but may still be very active in the child’s life (U.S. Department of Health and Human Services, 2000). Studies have found that the quality of parenting exhibited by fathers as well as the resources they provide to families are relevant in predicting youth problem behaviors as well as youth depression, 85
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self-esteem, and life satisfaction (Eggebeen, 2008). Within African American families, most parents value teaching their children about race through the process of racial socialization in efforts to protect them against discrimination and build positive culture awareness and identity (Brown, Linver, Evans, & DeGennaro, 2009). Racial socialization is defined as conveying and receiving messages about what it means to be black in this society, a process that teaches children to avoid or reduce race-related stress (Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010). Cultural parenting practices such as racial socialization are especially important to consider because they provide a protective buffer as well as promote positive youth developˆ & Sellers, 2009). The ment (Neblett, Smalls, Ford, Nguyen, Strong African American Family (SAAF), a program designed to decrease substance use, antisocial behavior, and early sexual initiation, found that parents who communicated messages about race were found to have children with increased protective factors such as negative attitudes toward substance abuse and early sexual activity (Murry, Berkel, Brody, Gerrard, & Gibbons, 2007). R.E.A.L.MEN, an HIV intervention program for adolescent boys and their fathers, found that those fathers who participated in the intervention program were more likely to communicate about sex with their sons. Furthermore, their sons were found to have higher rates of abstinence, condom use, and delayed sexual initiation (Dilorio, McCarty, Resnicow, Lehr, & Denzmore, 2007). In summary, factors such as engaging in culturally appropriate communication and active parenting activities could prove useful in improving communications between AAAMs and their fathers about issues related to sexual activity. The purpose of the current study is to determine which characteristics of the father–son relationship best predict communication about sex with fathers among African American boys who have nonresident fathers. Given the previous literature as stated above, we first hypothesize, boys who perceived their fathers as actively engaged in monitoring their behavior, involved in their lives, and communicated well in general will be more likely to communicate about sex with their fathers after controlling for demographic factors. Second, we hypothesize that racial socialization, as a cultural practice, will explain more variance in communication about sex beyond the previous variables because of the significance of this cultural practice from protecting youth from harm within African American families.
Methods Sample The sample for the current study comes from the Fathers and Sons Project. This study is a community-based 86
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participatory research project that involves a university, several community-based organizations, and the local health department in partnership. This study was developed to test the effectiveness of a family-centered intervention designed to reduce youth risky behaviors by strengthening bonds between nonresident African American fathers and their 8–12 year old sons (Caldwell et al., 2004). The intervention was based on theory and incorporated culture-specific activities in an effort to prevent substance abuse, violent behaviors, and early sexual debut among sons. Moreover, the intervention assisted fathers in learning more about the developmental needs of their sons (Caldwell et al., 2004). A quasiexperimental, pretest and posttest design was used to evaluate the effectiveness of the intervention program. Details of the intervention of the results have been reported elsewhere (Caldwell et al., 2004). For the purposes of the current study, we used baseline data for 345 sons from the intervention and comparison group prior to the implementation of the actual intervention. In a few instances where multiple sons participated (16%) in the study with their fathers, we based the analysis on data from the eldest son. Analysis comparing demographic characteristics from the sample showed number of siblings and age were the only two variables for which the two groups differed. Sons in the intervention group on average had more siblings than the comparison group and sons in the comparison group were older. Thus, number of siblings and age were used as covariates in multivariate analysis. The average age of the sons was 10.2 years old (SD = 1.4, range 8–12 years old); the average child had two siblings (SD = 1.53). Their average grade at the time of the study was about fifth grade (SD = 1.4). From the son’s perspective, 63.1% remembered living with their fathers at some time during their lifetime (see Table 1).
Data collection procedures Detailed recruitment procedures were described elsewhere (Caldwell, Bell, Brooks, Ward, & Jennings, 2010). In brief, consent was obtained from the father and from the mother for the child because he was a minor. Assent for the child’s own participation was also obtained. Institutional Review Board (IRB) approval was received from the governing institution as well as a local hospital (Caldwell, Bell, Brooks, Ward, & Jennings, 2010). Recruitment was also aided by community leadership in the research, which gave the project legitimacy in the community and encouraged families to participate who otherwise may have been reluctant to do so. Data were collected in face-to-face to interviews that lasted approximately 1 h. All interviewers were African American and all sons were paid $15 for the baseline interview.
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Table 1 Means, standard deviations, and correlations among study variables
Father–son sex communication Age Number of siblings Parental monitoring Involvement with father Communication with father Race socialization
N
M
SD
1
2
3
4
5
6
325 335 333 287 311 329 315
8.87 10.17 3.46 14.68 17.67 24.9 22.01
3.9 1.36 2.45 3.86 2.89 3.85 5.99
– 0.188** 0.017 0.344** 0.224** 0.228** 0.503**
– −0.001 −0.004 0.087 0.105 0.002
– −0.089 −0.106 −0.124* 0.024
– 0.500** 0.385** 0.374**
– 0.563** 0.346**
– 0.270**
7
Note. The n differs to missing data. *p < .05; **p < .001.
Measures Communication about sexual behavior. A 4item parent–child communication about sex scale was used to measure the son’s frequency in talking about sex with his father (Blake, Simskin, Ledsky, Perkins, & Calabrese, 2001). The frequency was assessed regarding how many times the sons discussed specific topics with their fathers (i.e., developing good relationships with girls, body changes during puberty, and when to have sex). A 4-point response scale was used that ranged from 1 = never to 4 = all of the time. Scores ranged from 4 to 16 with high scores indicating more frequent discussions. Cronbach’s alpha for the son’s pretest was 0.86. Age and siblings. Measures of age and number of siblings were measured with standard demographic questions. Parental monitoring. A 4-item parental monitoring scale (Jacobson & Crockett, 2000) assessed the sons’ perception of their fathers’ knowledge, perception and awareness of their activities and whereabouts (i.e., how much my father knows about my friends, how well I am doing in school, and how much my father knows about my homework habits). Response options ranged from 1 = nothing at all to 4 = a lot. The four questions and response options ranged from 4 to 16, with higher scores indicating more perceived parental monitoring from fathers. Cronbach’s alpha for the pretest was 0.70. Parental involvement. We used a 5-item measure to assess son’s perception of father’s involvement patterns such as protecting sons, showing sons love and affection, and serving as a role model to their sons. Scores ranged from 5 to 25. The scores were reversed to indicate more father involvement; higher scores indicated more satisfaction with fathers’ involvement with sons. Responses ranged from 1 = very happy to 4 = very unhappy. Cronbach’s alpha for the pretest was 0.72. General communication. An 8-item Olson and Barnes’ Communication Scale (1985) was adapted and used to measure the degree of openness of father–son communication (i.e., my father and I can talk about
anything, when I ask a question I feel that I get honest answers from my father). A 4-point response scale ranged from 1 = agree a lot to 4 = disagree a lot. Scores ranged from 8 to 32. This scale was reversed so that high scores indicate better general communication. Cronbach’s alpha for this measure at pretest was 0.65 (note original scale was composed of two subscales, alpha reliabilities for each subscale was 0.87 and 0.78; Olson & Barnes, 1985). Race socialization. The Race Socialization Scale (Thorton, Chatter, Taylor, & Allen, 1990) is an 8-item measure of what fathers taught sons about what it means to be black (i.e., tell you that everyone is the same, you should try to get along with everybody, and tell you to be proud of your black history). Response options ranged from 1 = never to 4 = all of the time. Scores ranged from 8 to 32. Higher scores indicated that sons received more messages about racial issues with their fathers. Cronbach’s alpha for the pretest was 0.76.
Data analysis approach SPSS statistical 19.0 software package was used to analyze data. Means, standard deviations, and Pearson correlations were used for descriptive analysis (see Table 1) Hierarchal multiple regression was conducted to assess the influence of parental monitoring, father involvement, general communication, and race socialization on father and son communication about sex. Age and number of siblings were used as control variables in multivariate analysis. A preliminary analysis was performed to confirm that all regression assumptions were met. The control variables were entered in step 1, followed by the first three parenting variables in step 2. The final step entered the race socialization variable.
Results Table 1 shows the results of the correlation analysis. Families with more siblings who perceived their parents monitoring them and greater father involvement were linked with higher levels of general communication with 87
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their fathers. There was a strong correlation between parental monitoring and father involvement. Sons who were exposed to messages about race were associated with more parental monitoring, father involvement, and general communication. Sons who were older communicated more with their fathers about sex than younger boys. Likewise, parental monitoring, sons’ satisfaction with father involvement, overall general communication, and race socialization were all positively correlated with communication about sex. The results of the hierarchal multiple regression (see Table 2) were performed to predict communication about sex between fathers and sons. The results indicated that the control variables in step 1 accounted for 2.9% of communication about sex. Parenting variables entered at the second step accounted for an additional 12.6% variance; however, only parental monitoring was a significant predictor of communication about sex. This partially supported our first hypothesis, because more discussions with fathers and sons about sex was only associated with one of the three variables (i.e., sons perceiving that their fathers were engaged in monitoring them). Additionally, as more variables were added, in step 2, number of siblings was removed because of the small contribution it made toward the model. Entering the variable race socialization as the final step in the model revealed the largest change in R2 (0.146) and explained the most variance (30.4%), thereby contributing to at least half of the explained variance in the overall model. Our second hypothesis was fully supported, as racial socialization was associated with more communication about sexual issues between father and son. Overall, results showed that perceptions of parental monitoring and racial socializations from sons were associated with talking more about sex with their fathers; racial socialization had a greater association with communication about sex between sons and their fathers than parental monitoring. In the final model all variables were statistically significant (see Table 2).
Table 2 Hierarchal multiple regression analysis for father–son communication about sex (N = 345) Step 1 2
3
Predictor
Step 1
Step 2
Step 3
Age Parenting variables 1. Communication with father 2. Parental monitoring 3. Involvement with father 4. Race socialization Adjusted R2 R2 change F-statistic
0.180**
0.173**
0.188***
**p < .01; ***p < .001.
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0.059 0.320*** 0.01 0.029 9.491**
0.146 0.126 13.22***
0.018 0.221*** −0.006 0.419*** 0.291 0.146 24.522***
Discussion The purpose of this study was to determine the influence of race socialization and father involvement on communication between AAAMs and their nonresident fathers about sex. A key finding that parental monitoring was significant within the model was consistent with previous literature. In the analysis we found that fathers who do not live with their sons but who monitor their children are more likely to have communication with those sons about issues related to sex. Additionally, those fathers who expose their children to messages about race also are more likely to communicate about sexual issues. What is distinctive about the findings of racial socialization and its relationship to father–son communication about sex is that race socialization has often been studied to predict psychosocial and academic achievements during child development (Brown et al., 2009; Miller, 1999; Neblett et al., 2009;). Few studies, and in particular in the field of nursing, have examined the significance of race socialization on sexual risk behaviors or health by African American fathers. While general communication and father involvement may indicate availability of parents to discuss risk behaviors with their children, there is something unique to be said about racial socialization and parental monitoring as protective strategies against youth risky behaviors. Parents who provide messages about race and monitor their children may in fact be engaged in and more aware of the challenges that their children are likely to face in a race conscious society. These same parents provide a protective buffer for their children. Discussing messages about race, identity, and the significance and meanings of race may need to be emphasized more during sexual discussions. As a result, male youth may learn to reject stereotypic sexual images and foster an increased self-esteem (Murry, Brody, Simons,Cutrona, & Gibbons, 2008). Furthermore, race socialization may serve as an important mediating factor to improving positive social perceptions and sexual outcomes in male youth (Neblett et al., 2009). Further research should examine these linkages.
Limitations There were several limitations that may need further evaluation through future research. First, the internal consistency reliability for general communication was 0.65; coefficients in the range of 0.70 or above are generally preferred (Polit, 2010). This may be because of the small number of questions intended for this measure, which is just four items versus the original scale that was composed of 10 items; however, the measure was sufficient to indicate some level of reliability for the sample.
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Another limitation is that this is a cross-sectional study. While these types of studies are often used in sexuality research, causality cannot be assumed. In this instance it is not determined whether racial identity predicts sexual discussion or vice versa. Further research is warranted to determine the direction of causality that exists between these two variables. Last, this analysis does not explore what the sons would like to discuss with their fathers and the comfort level of their discussion. This sample is exclusively composed of African American nonresident fathers and their sons; the selected sample is not representative of all nonresident fathers or sons. Additional research would need to explore the potential of these finding being generalizable to other populations of male youth with nonresident fathers. The study is unique for health promotion and risk reduction factors. The indicators in this study that have been found for communication about sex for African American nonresident fathers and their sons could be pivotal in strengthening parenting behaviors and communication patterns about sex.
Implications for nurse practitioners Adequate preparation for sex education is a difficult topic and at times requires the facilitation of other people who may share a key relationship with the family, such as the child’s healthcare provider. It is important for African American fathers and their sons to communicate about sex at the appropriate developmental stage. One primary source of guidance for parents concerning their child’s health is their pediatric healthcare provider, particularly nurse practitioners (NPs). Their job is to ensure that families receive appropriate preventative instruction, quality health care, and to meet the psychosocial and physical care needs of their patients. In addition, pediatric healthcare providers are there to encourage and offer parents resources to assist with their communication efforts at home and other settings (Miller, Wyckoff, Lin, Whitaker, & Sukalac, 2008). Thus, when providing anticipatory guidance and the father is not present, double check to see what male figure is in the household, tell the parent to share the information with the father and encourage him to come to the next visit. Because nonresident fathers spend less time with their children, they may need more assistance in conveying certain messages to their children (Caldwell et al., 2010). For that reason, stressing the importance of role modeling, support, involvement, openness, and providing information at an early age is vital. This can serve as a teachable moment and provides an opportunity for fathers to be more active in their son’s sexual heath. Fathers who are more frequently involved with their child can have a positive influence on their life
(Caldwell et al., 2010). Providers who counsel parents, in particular fathers, regarding sex and communication are in a unique position to increase these parenting skills and can help put sexuality education in a lifelong perspective (American Academy of Pediatrics, 2005). Our findings may be valuable for parents, nurses, and NPs who provide primary care to this population. Healthcare providers such as NPs are in an ideal position to model and incorporate education messages into clinical practice. For example, NPs can inform families of the importance of introducing these messages to African American male youth during their transition to adolescence. Exposure to these messages may be more beneficial to this population as they can help to develop a positive racial identity and self-esteem (Murry et al., 2007). These factors are important as they may effectively prepare AAAMs to make the appropriate decisions about sexual behaviors in the context of peers and mainstream society (Neblett et al., 2009). Thus, it is critical for providers to support parents in clearly articulating their messages about the expectations of risk and race socialization and the importance of monitoring their son’s activities to avoid such risk behaviors (Murry et al., 2007). It is also important to remind parents that their cultural values also translate into their relationship values. These messages should be included in the anticipatory guidance teaching and during peak times and visits (i.e., well child visits, preadolescence).
Conclusion Recognizing the importance of communication patterns about sex between African American nonresident fathers and their sons is critical in preparing adolescent males to understand sexual health and risk behaviors. Thus, teaching fathers, especially nonresident fathers, to discuss sexual health and coping strategies with their young sons during this unique developmental time is essential. When working with African American families, fathers who monitor their children and teach them about racial issues may be especially receptive to learning more about how to be better sexual health educators for their children. For that reason, information and clinical support should be readily available and provided.
Acknowledgments This research was funded by the Centers for Disease Control and Prevention through Grant #R06/CCR521580 to the second author. Partial support was provided through the Community Foundation of Flint. A special thank you to the Flint Fathers and Sons Steering Committee and MICHR staff. 89
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sexual risk behaviors among urban adolescent females: A prospective study. Journal of Adolescent Health, 33, 98–107. doi:10.1016/S1054139X(03)00183-6 Hutchinson, M. K., & Montgomery, A. J. (2007). Parent communication and sexual risk among African Americans. Western Journal of Nursing Research, 29(6), 691–707. doi:10.1177/0193945906297374 Jacobson, K. C., & Crockett, L. J. (2000). Parental monitoring and adolescent adjustment: An ecological perspective. Journal of Research, 10(1), 65–67. Retrieved from http://digitalcommons.unl.edu/psychfacpub/231/ Lehr, S. T., Demi, A. S., Dilorio, C., & Facteau, J. (2005). Predictors of father-son communication about sexuality. Journal of Sex Research, 42(2), 119–129. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16123842 Leland, N. L., & Barth, R. P. (1993). Characteristics of adolescents who have attempted to avoid HIV and who have communicated with parents about sex. Journal Of Adolescent Research, 8(1), 58–76. doi:10.1177/074355489381005 Martino, S. C., Elliott, M. N., Corona, R., Kanouse, D. E., & Schuster, M. A. (2008). Beyond the “big talk”: The roles of breadth and repetition in parent-adolescent communication about sexual topics. Pediatrics, 121(3), e612–e618. doi:10.1542/peds.2007-2156 Miller, D. B. (1999). Racial socialization and racial identity: Can they promote resiliency for African American Adolescents? Adolescence, 34, 493–501. Miller, K. S., Wyckoff, Æ. S. C., Lin, Æ. C. Y., Whitaker, D. J., & Sukalac, Æ. T. (2008). Pediatricians’ role and practices regarding provision of guidance about sexual risk reduction to parents, 29(3), 279–291. doi:10.1007/s10935-008-0137-9 Murry, V. M., Berkel, C., Brody, G. H., Gerrard, M., & Gibbons, F. X. (2007). The strong African American families program: Longitudinal pathways to sexual risk reduction. Journal of Adolescent Health, 41(4), 333–342. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8& NEWS=N&AN=2007446226 Murry, V. M., Brody, G. H., Simons, R. L., Cutrona, C. E., & Gibbons, F. X. (2008). Disentangling ethnicity and context as predictors of parenting within rural African American families. Applied Developmental Science, 12(4), 202–210. doi:10.1080/10888690802388144 ˆ H. X., & Sellers, R. M. (2009). Neblett, E. W., Smalls, C. P., Ford, K. R., Nguyen, Racial socialization and racial identity: African American parents’ messages about race as precursors to identity. Journal of Youth and Adolescence, 38(2), 189–203. doi:10.1007/s10964-008-9359-7 Ohalete, N. (2007). Adolescent sexual debut: A case for studying African American father-adolescent reproductive health communication. Journal of Black Studies, 37(5), 737–752. doi:10.1177/0021934705283769 Olson, D. H., & Barnes, H. L. (1985). Parent-adolescent communication and the circumplex model. Child Development, 56(2), 438–447. Park, M. J., & Breland, D. (2007). Starting on a healthy path: Promotion of young men’s sexual health. American Journal of Men’s Health, 1(2), 148–153. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19482791 Polit, D. (2010). Statistics and data analysis for nursing research (2nd ed.). Saddle River, NJ: Pearson. Rutledge, T. F., & Boyd, M. F. (2010). Youth risk behavior surveillance—United States, 2009. Morbidity and Mortality Weekly Report, 59(SS-5), 1–148. Thornton, M. C., Chatters, L. M., Taylor, R. J., & Allen, W. R. (1990). Sociodemographic and environmental correlates of racial socialization by black. Internet Research, 14(4), e99. doi:10.2196/jmir.2178 U.S. Department of Health and Human Services. (2000). Involving non-resident fathers in children’s learning (chapter 2). Retrieved from http://fatherhood.hhs.gov/involv-non-res00/chapter2.htm Wright, P. J. (2009). Father-child sexual communication in the United States: A review and synthesis. Journal of Family Communication, 9(4), 233–250. doi:10.1080/15267430903221880 Wyckoff, S. C., Miller, K. S., Forehand, R., Bau, J. J., Fasula, A., Long, N., & Armistead, L. (2007). Patterns of sexuality communication between preadolescents and their mothers and fathers. Journal of Child and Family Studies, 17(5), 649–662. doi:10.1007/s10826-007-9179-5
Breaking the ice! Predictors about communication between nonresident African American fathers and sons about sex Jade C. Burns, MSN, RN, CPNP-PC (PhD Candidate)1 & Cleopatra H. Caldwell, PhD (Professor)2 1
School of Nursing, University of Michigan, Ann Arbor, Michigan Department of Health Behavior & Health Education, Center for Research on Ethnicity, Culture & Health, School of Public Health, University of Michigan, Ann Arbor, Michigan
2
Keywords African American; parenting; adolescents; sexual health. Correspondence Jade C. Burns, MSN, RN, CPNP-PC, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109. Tel: 734-647-3176; Fax: 734-763-7379; E-mail: [email protected] Received: 7 May 2014; accepted: 16 February 2015 doi: 10.1002/2327-6924.12252 Disclosure This material has been presented at several conferences previously. All authors have contributed extensively to the work presented in this article. Jade Burns prepared the manuscript, including data analysis and interpretation. Dr. Cleopatra Caldwell, principal investigator for the Fathers and Son’s project, provided (a) data set for the development of the research topic; (2) guided analysis, interpretation; and (3) critical revision and final approval of the manuscript. The authors declare that there is no conflict of interest.
Abstract Background and purpose: Research on communication between resident and nonresident African American fathers and their sons about sex has been understudied. The purpose of this study is to determine the influence of parenting variables, specifically, racial socialization and father involvement on nonresident African American father–son communication about sex. Methods: Data for this study are from the Fathers and Sons Project. This intervention study is designed to enhance relationships between nonresident African American fathers and their 8–12 year old sons and to prevent risky health behaviors among sons. The present study is based on 345 African American boys who completed baseline face-to-face interviews. The average age of the sons was 10.2 years old (SD = 1.4), with an average of two siblings (SD = 1.53). Results: Age and sons’ perceptions of more parental monitoring by their fathers were predictive of increased communication about sex. Racial socialization messages explained additional variance in communication about sex above other parenting variables and controls. Implications for practice: Findings suggest when working with African American families, providers who counsel parents, and in particular provide outreach to fathers regarding communication about sex, are in a unique position to enhance parenting communication skills about sexuality.
Risky sexual activity is a major concern in the United States. The efforts to decrease risky sexual behavior have been supported by national reports such as Healthy People 2020 and the Youth Risk Behavior Surveillance System (YRBSS). African American adolescent males (AAAMs) engage in risky sexual behaviors and have higher rates of early sexual debut than adolescents of other race and gender subgroups, often initiating sex prior to the age of 13 (Bakken & Winter, 2002; Fergus, Zimmerman, & Caldwell, 2007; Rutledge & Boyd, 2010). AAAMs also are disproportionately affected by sexually transmitted infections (STIs). Park and Breland (2007) reported that the majority (55%) of new HIV infections occurred in AAAMs ages 13–24. Moreover, AAAMs are screened less frequently, have
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more underreported STIs, and use healthcare resources less often than adolescent females (Collins & Champion, 2009). Despite the attention of public health agencies and others to create programs to reduce or prevent risky sexual behaviors, few programs have been designed solely for adolescent males and even fewer for AAAMs. According to a study based on the National Survey of Adolescent Males (NSAM), some reasons may include difficulty in recruiting and lack of health data collected on adolescent male sexual behavior (Dariotis, Sifakis, Astone, Pleck, & Sonenstein, 2011). Thus, it is evident that more studies are needed on the sexual health needs of AAAMs. Consistent findings have suggested that knowledge alone is not associated with health behavior change in
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interventions designed to prevent or reduce adolescent risky sexual behavior (Lehr, Demi, Dilorio, & Facteau, 2005). It is well established that discussions between parent and child are one of the best protectors in reducing risky sexual behaviors and early sexual initiation in youth (Clawson & Reese-Weber, 2003; Lehr et al., 2005; Leland & Barth, 1993; Wright, 2009). Additionally, the literature indicates that within the family, mothers are the main communicators for sex education (Hutchinson, Jemmott, Jemmott, Braverman, & Fong, 2003; Lehr et al., 2005; Ohalete, 2007; Wright, 2009). Although parents can educate their children about sex and influence their sexual decision making, much of this literature has not critically examined sexual communication with African Americans or attempted to understand the role of culture in these discussions. Further, the influence of the involvement and discussion between fathers and their children about sex are not often examined. Thus, the purpose of this study was to determine the influence of race socialization and father involvement on communication between African American boys and their nonresident fathers about sex. The results of this study may be useful in clinical practice when working with fathers to help them become more effective in their communication skills about sex with their sons.
Review of the literature Parent–adolescent communication about sex Research has demonstrated that parental communication about sex has been associated with less sexual behavior and later sexual initiation among youth regardless of race or gender (Wright, 2009; Wyckoff et al., 2007). Parents have the ability to teach preventative strategies to their children, which can improve the reduction of risky behaviors associated with early sexual initiation such as substance abuse and tobacco use. Parents also reduce the likelihood that their adolescents will engage in such risky behaviors through relational warmth, connectedness, and through parental monitoring of their children’s activities (Wright, 2009). Studies also have shown that there are wide ranges of predictive factors that relate to parent–child communication about sexual issues. Factors such as family openness and general communication have been found to influence discussions about sex (Lehr et al., 2005), with repetition of sexual topics discussed creating a comfortable and open environment in which a wide range of sexual topics are discussed (Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010; Martino, Elliot, Corona, Kanouse, & Schuster, 2008). Dilorio, McCarty, and Denzmore (2006) found that self-efficacy and outcome expectations related to talking about sexual issues were high in father–son communication.
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Gender and pubertal development influence the timing of discussions between parent and child, with parents talking with daughters more than sons and with older rather than younger children (Lehr et al., 2005; Ohalete, 2007; Wright, 2009). Parenting style, frequency of conversations, current relationship between parent and child, and cultural norms also influence these conversations (Hutchinson & Montgomery, 2007). Other family and individual factors that link to a delay in sexual debut, including religious affiliation, self-esteem, higher grade point average, increased levels of family connectedness, parental support, perceived parental disapproval, and monitoring, were also found to delay sexual debut (Caldwell, Rafferty, De Loney, & Brooks, 2010; Ohalete, 2007). These factors are critical to consider when assessing parent–child communication about sex because they represent explanatory motivations as to why parents may or may not discuss sexual issues with their children. Although discussions of sexual topics usually occur during adolescence, previous studies have indicated that preadolescence may be the best time to discuss sexual health from a prevention perspective (Wyckoff et al., 2007). Preadolescence occurs by the time a child reaches the age of 8 and is marked by the onset of pubertal changes (Burns, Dunn, Brady, Starr, & Blosser, 2009). At this age, children begin to understand sexuality and the changes that occur within their bodies (Burns et al., 2008). Preadolescents are also at a cognitive stage where they can internalize the messages that their parents are conveying about sex in age appropriate ways (Wright, 2009). Children at this age are curious and have an increased sexual awareness; therefore, preadolescence provides the perfect time to discuss topics related to sexual behavior. Ideally, messages regarding sexual behavior should be transmitted before the onset of sexual risk behaviors occurs. It is vital to reach children at an early age so they can make informed sexual decisions based on family values as they mature into adolescence. This should occur before peers or media have an influence on their opinions and sexual decision-making processes.
African American fathers and sexual communication More studies of the influence of nonresidential fathers on their children have emerged in the literature in recent years. A nonresident father is one who does not live in the same home as his child and may be separated, divorced, or never married to the child’s mother but may still be very active in the child’s life (U.S. Department of Health and Human Services, 2000). Studies have found that the quality of parenting exhibited by fathers as well as the resources they provide to families are relevant in predicting youth problem behaviors as well as youth depression, 85
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self-esteem, and life satisfaction (Eggebeen, 2008). Within African American families, most parents value teaching their children about race through the process of racial socialization in efforts to protect them against discrimination and build positive culture awareness and identity (Brown, Linver, Evans, & DeGennaro, 2009). Racial socialization is defined as conveying and receiving messages about what it means to be black in this society, a process that teaches children to avoid or reduce race-related stress (Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010). Cultural parenting practices such as racial socialization are especially important to consider because they provide a protective buffer as well as promote positive youth developˆ & Sellers, 2009). The ment (Neblett, Smalls, Ford, Nguyen, Strong African American Family (SAAF), a program designed to decrease substance use, antisocial behavior, and early sexual initiation, found that parents who communicated messages about race were found to have children with increased protective factors such as negative attitudes toward substance abuse and early sexual activity (Murry, Berkel, Brody, Gerrard, & Gibbons, 2007). R.E.A.L.MEN, an HIV intervention program for adolescent boys and their fathers, found that those fathers who participated in the intervention program were more likely to communicate about sex with their sons. Furthermore, their sons were found to have higher rates of abstinence, condom use, and delayed sexual initiation (Dilorio, McCarty, Resnicow, Lehr, & Denzmore, 2007). In summary, factors such as engaging in culturally appropriate communication and active parenting activities could prove useful in improving communications between AAAMs and their fathers about issues related to sexual activity. The purpose of the current study is to determine which characteristics of the father–son relationship best predict communication about sex with fathers among African American boys who have nonresident fathers. Given the previous literature as stated above, we first hypothesize, boys who perceived their fathers as actively engaged in monitoring their behavior, involved in their lives, and communicated well in general will be more likely to communicate about sex with their fathers after controlling for demographic factors. Second, we hypothesize that racial socialization, as a cultural practice, will explain more variance in communication about sex beyond the previous variables because of the significance of this cultural practice from protecting youth from harm within African American families.
Methods Sample The sample for the current study comes from the Fathers and Sons Project. This study is a community-based 86
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participatory research project that involves a university, several community-based organizations, and the local health department in partnership. This study was developed to test the effectiveness of a family-centered intervention designed to reduce youth risky behaviors by strengthening bonds between nonresident African American fathers and their 8–12 year old sons (Caldwell et al., 2004). The intervention was based on theory and incorporated culture-specific activities in an effort to prevent substance abuse, violent behaviors, and early sexual debut among sons. Moreover, the intervention assisted fathers in learning more about the developmental needs of their sons (Caldwell et al., 2004). A quasiexperimental, pretest and posttest design was used to evaluate the effectiveness of the intervention program. Details of the intervention of the results have been reported elsewhere (Caldwell et al., 2004). For the purposes of the current study, we used baseline data for 345 sons from the intervention and comparison group prior to the implementation of the actual intervention. In a few instances where multiple sons participated (16%) in the study with their fathers, we based the analysis on data from the eldest son. Analysis comparing demographic characteristics from the sample showed number of siblings and age were the only two variables for which the two groups differed. Sons in the intervention group on average had more siblings than the comparison group and sons in the comparison group were older. Thus, number of siblings and age were used as covariates in multivariate analysis. The average age of the sons was 10.2 years old (SD = 1.4, range 8–12 years old); the average child had two siblings (SD = 1.53). Their average grade at the time of the study was about fifth grade (SD = 1.4). From the son’s perspective, 63.1% remembered living with their fathers at some time during their lifetime (see Table 1).
Data collection procedures Detailed recruitment procedures were described elsewhere (Caldwell, Bell, Brooks, Ward, & Jennings, 2010). In brief, consent was obtained from the father and from the mother for the child because he was a minor. Assent for the child’s own participation was also obtained. Institutional Review Board (IRB) approval was received from the governing institution as well as a local hospital (Caldwell, Bell, Brooks, Ward, & Jennings, 2010). Recruitment was also aided by community leadership in the research, which gave the project legitimacy in the community and encouraged families to participate who otherwise may have been reluctant to do so. Data were collected in face-to-face to interviews that lasted approximately 1 h. All interviewers were African American and all sons were paid $15 for the baseline interview.
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Table 1 Means, standard deviations, and correlations among study variables
Father–son sex communication Age Number of siblings Parental monitoring Involvement with father Communication with father Race socialization
N
M
SD
1
2
3
4
5
6
325 335 333 287 311 329 315
8.87 10.17 3.46 14.68 17.67 24.9 22.01
3.9 1.36 2.45 3.86 2.89 3.85 5.99
– 0.188** 0.017 0.344** 0.224** 0.228** 0.503**
– −0.001 −0.004 0.087 0.105 0.002
– −0.089 −0.106 −0.124* 0.024
– 0.500** 0.385** 0.374**
– 0.563** 0.346**
– 0.270**
7
Note. The n differs to missing data. *p < .05; **p < .001.
Measures Communication about sexual behavior. A 4item parent–child communication about sex scale was used to measure the son’s frequency in talking about sex with his father (Blake, Simskin, Ledsky, Perkins, & Calabrese, 2001). The frequency was assessed regarding how many times the sons discussed specific topics with their fathers (i.e., developing good relationships with girls, body changes during puberty, and when to have sex). A 4-point response scale was used that ranged from 1 = never to 4 = all of the time. Scores ranged from 4 to 16 with high scores indicating more frequent discussions. Cronbach’s alpha for the son’s pretest was 0.86. Age and siblings. Measures of age and number of siblings were measured with standard demographic questions. Parental monitoring. A 4-item parental monitoring scale (Jacobson & Crockett, 2000) assessed the sons’ perception of their fathers’ knowledge, perception and awareness of their activities and whereabouts (i.e., how much my father knows about my friends, how well I am doing in school, and how much my father knows about my homework habits). Response options ranged from 1 = nothing at all to 4 = a lot. The four questions and response options ranged from 4 to 16, with higher scores indicating more perceived parental monitoring from fathers. Cronbach’s alpha for the pretest was 0.70. Parental involvement. We used a 5-item measure to assess son’s perception of father’s involvement patterns such as protecting sons, showing sons love and affection, and serving as a role model to their sons. Scores ranged from 5 to 25. The scores were reversed to indicate more father involvement; higher scores indicated more satisfaction with fathers’ involvement with sons. Responses ranged from 1 = very happy to 4 = very unhappy. Cronbach’s alpha for the pretest was 0.72. General communication. An 8-item Olson and Barnes’ Communication Scale (1985) was adapted and used to measure the degree of openness of father–son communication (i.e., my father and I can talk about
anything, when I ask a question I feel that I get honest answers from my father). A 4-point response scale ranged from 1 = agree a lot to 4 = disagree a lot. Scores ranged from 8 to 32. This scale was reversed so that high scores indicate better general communication. Cronbach’s alpha for this measure at pretest was 0.65 (note original scale was composed of two subscales, alpha reliabilities for each subscale was 0.87 and 0.78; Olson & Barnes, 1985). Race socialization. The Race Socialization Scale (Thorton, Chatter, Taylor, & Allen, 1990) is an 8-item measure of what fathers taught sons about what it means to be black (i.e., tell you that everyone is the same, you should try to get along with everybody, and tell you to be proud of your black history). Response options ranged from 1 = never to 4 = all of the time. Scores ranged from 8 to 32. Higher scores indicated that sons received more messages about racial issues with their fathers. Cronbach’s alpha for the pretest was 0.76.
Data analysis approach SPSS statistical 19.0 software package was used to analyze data. Means, standard deviations, and Pearson correlations were used for descriptive analysis (see Table 1) Hierarchal multiple regression was conducted to assess the influence of parental monitoring, father involvement, general communication, and race socialization on father and son communication about sex. Age and number of siblings were used as control variables in multivariate analysis. A preliminary analysis was performed to confirm that all regression assumptions were met. The control variables were entered in step 1, followed by the first three parenting variables in step 2. The final step entered the race socialization variable.
Results Table 1 shows the results of the correlation analysis. Families with more siblings who perceived their parents monitoring them and greater father involvement were linked with higher levels of general communication with 87
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their fathers. There was a strong correlation between parental monitoring and father involvement. Sons who were exposed to messages about race were associated with more parental monitoring, father involvement, and general communication. Sons who were older communicated more with their fathers about sex than younger boys. Likewise, parental monitoring, sons’ satisfaction with father involvement, overall general communication, and race socialization were all positively correlated with communication about sex. The results of the hierarchal multiple regression (see Table 2) were performed to predict communication about sex between fathers and sons. The results indicated that the control variables in step 1 accounted for 2.9% of communication about sex. Parenting variables entered at the second step accounted for an additional 12.6% variance; however, only parental monitoring was a significant predictor of communication about sex. This partially supported our first hypothesis, because more discussions with fathers and sons about sex was only associated with one of the three variables (i.e., sons perceiving that their fathers were engaged in monitoring them). Additionally, as more variables were added, in step 2, number of siblings was removed because of the small contribution it made toward the model. Entering the variable race socialization as the final step in the model revealed the largest change in R2 (0.146) and explained the most variance (30.4%), thereby contributing to at least half of the explained variance in the overall model. Our second hypothesis was fully supported, as racial socialization was associated with more communication about sexual issues between father and son. Overall, results showed that perceptions of parental monitoring and racial socializations from sons were associated with talking more about sex with their fathers; racial socialization had a greater association with communication about sex between sons and their fathers than parental monitoring. In the final model all variables were statistically significant (see Table 2).
Table 2 Hierarchal multiple regression analysis for father–son communication about sex (N = 345) Step 1 2
3
Predictor
Step 1
Step 2
Step 3
Age Parenting variables 1. Communication with father 2. Parental monitoring 3. Involvement with father 4. Race socialization Adjusted R2 R2 change F-statistic
0.180**
0.173**
0.188***
**p < .01; ***p < .001.
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0.059 0.320*** 0.01 0.029 9.491**
0.146 0.126 13.22***
0.018 0.221*** −0.006 0.419*** 0.291 0.146 24.522***
Discussion The purpose of this study was to determine the influence of race socialization and father involvement on communication between AAAMs and their nonresident fathers about sex. A key finding that parental monitoring was significant within the model was consistent with previous literature. In the analysis we found that fathers who do not live with their sons but who monitor their children are more likely to have communication with those sons about issues related to sex. Additionally, those fathers who expose their children to messages about race also are more likely to communicate about sexual issues. What is distinctive about the findings of racial socialization and its relationship to father–son communication about sex is that race socialization has often been studied to predict psychosocial and academic achievements during child development (Brown et al., 2009; Miller, 1999; Neblett et al., 2009;). Few studies, and in particular in the field of nursing, have examined the significance of race socialization on sexual risk behaviors or health by African American fathers. While general communication and father involvement may indicate availability of parents to discuss risk behaviors with their children, there is something unique to be said about racial socialization and parental monitoring as protective strategies against youth risky behaviors. Parents who provide messages about race and monitor their children may in fact be engaged in and more aware of the challenges that their children are likely to face in a race conscious society. These same parents provide a protective buffer for their children. Discussing messages about race, identity, and the significance and meanings of race may need to be emphasized more during sexual discussions. As a result, male youth may learn to reject stereotypic sexual images and foster an increased self-esteem (Murry, Brody, Simons,Cutrona, & Gibbons, 2008). Furthermore, race socialization may serve as an important mediating factor to improving positive social perceptions and sexual outcomes in male youth (Neblett et al., 2009). Further research should examine these linkages.
Limitations There were several limitations that may need further evaluation through future research. First, the internal consistency reliability for general communication was 0.65; coefficients in the range of 0.70 or above are generally preferred (Polit, 2010). This may be because of the small number of questions intended for this measure, which is just four items versus the original scale that was composed of 10 items; however, the measure was sufficient to indicate some level of reliability for the sample.
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Another limitation is that this is a cross-sectional study. While these types of studies are often used in sexuality research, causality cannot be assumed. In this instance it is not determined whether racial identity predicts sexual discussion or vice versa. Further research is warranted to determine the direction of causality that exists between these two variables. Last, this analysis does not explore what the sons would like to discuss with their fathers and the comfort level of their discussion. This sample is exclusively composed of African American nonresident fathers and their sons; the selected sample is not representative of all nonresident fathers or sons. Additional research would need to explore the potential of these finding being generalizable to other populations of male youth with nonresident fathers. The study is unique for health promotion and risk reduction factors. The indicators in this study that have been found for communication about sex for African American nonresident fathers and their sons could be pivotal in strengthening parenting behaviors and communication patterns about sex.
Implications for nurse practitioners Adequate preparation for sex education is a difficult topic and at times requires the facilitation of other people who may share a key relationship with the family, such as the child’s healthcare provider. It is important for African American fathers and their sons to communicate about sex at the appropriate developmental stage. One primary source of guidance for parents concerning their child’s health is their pediatric healthcare provider, particularly nurse practitioners (NPs). Their job is to ensure that families receive appropriate preventative instruction, quality health care, and to meet the psychosocial and physical care needs of their patients. In addition, pediatric healthcare providers are there to encourage and offer parents resources to assist with their communication efforts at home and other settings (Miller, Wyckoff, Lin, Whitaker, & Sukalac, 2008). Thus, when providing anticipatory guidance and the father is not present, double check to see what male figure is in the household, tell the parent to share the information with the father and encourage him to come to the next visit. Because nonresident fathers spend less time with their children, they may need more assistance in conveying certain messages to their children (Caldwell et al., 2010). For that reason, stressing the importance of role modeling, support, involvement, openness, and providing information at an early age is vital. This can serve as a teachable moment and provides an opportunity for fathers to be more active in their son’s sexual heath. Fathers who are more frequently involved with their child can have a positive influence on their life
(Caldwell et al., 2010). Providers who counsel parents, in particular fathers, regarding sex and communication are in a unique position to increase these parenting skills and can help put sexuality education in a lifelong perspective (American Academy of Pediatrics, 2005). Our findings may be valuable for parents, nurses, and NPs who provide primary care to this population. Healthcare providers such as NPs are in an ideal position to model and incorporate education messages into clinical practice. For example, NPs can inform families of the importance of introducing these messages to African American male youth during their transition to adolescence. Exposure to these messages may be more beneficial to this population as they can help to develop a positive racial identity and self-esteem (Murry et al., 2007). These factors are important as they may effectively prepare AAAMs to make the appropriate decisions about sexual behaviors in the context of peers and mainstream society (Neblett et al., 2009). Thus, it is critical for providers to support parents in clearly articulating their messages about the expectations of risk and race socialization and the importance of monitoring their son’s activities to avoid such risk behaviors (Murry et al., 2007). It is also important to remind parents that their cultural values also translate into their relationship values. These messages should be included in the anticipatory guidance teaching and during peak times and visits (i.e., well child visits, preadolescence).
Conclusion Recognizing the importance of communication patterns about sex between African American nonresident fathers and their sons is critical in preparing adolescent males to understand sexual health and risk behaviors. Thus, teaching fathers, especially nonresident fathers, to discuss sexual health and coping strategies with their young sons during this unique developmental time is essential. When working with African American families, fathers who monitor their children and teach them about racial issues may be especially receptive to learning more about how to be better sexual health educators for their children. For that reason, information and clinical support should be readily available and provided.
Acknowledgments This research was funded by the Centers for Disease Control and Prevention through Grant #R06/CCR521580 to the second author. Partial support was provided through the Community Foundation of Flint. A special thank you to the Flint Fathers and Sons Steering Committee and MICHR staff. 89
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