Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Stephanie Marhefka, Ph.D., M.S.

Co-Major Professor

Cheryl Vamos, Ph.D., M.P.H.

Committee Member

Roneé E. Wilson, Ph.D., M.P.H.

Committee Member

Deborah Austin, Ph.D., M.S.

Keywords

Sexuality, Reproductive Health, Child Health, Parent-Child Relationship

Abstract

Background: Approximately 50% of African American (AA) high school students are sexually active and a large proportion of sexually active AA students report engaging in sexual risk behaviors such as not using condoms at last intercourse. Consequently, AA adolescents in the United States experience outcomes of risky sexual behaviors at high rates. Evidence shows parents have an effect on shaping adolescent attitudes, values, and beliefs regarding sex through sexual risk communication (SRC). Although parent-adolescent SRC is associated with reductions in sexual risk behaviors among AA adolescents, research has primarily focused on mothers. While parents acknowledge that SRC is traditionally viewed as the mother’s responsibility, many feel that father-adolescent SRC is important. Additionally, there is a dearth of literature focused on father-adolescent SRC among AAs.

Purpose: The purpose of this study is to identify and describe factors that contribute to the sexual risk communication behaviors of AA fathers of 13-17 year old adolescents. SRC in this study will include communication regarding abstaining from sexual intercourse, condom and contraceptive use, and having multiple sexual partners. SRC behaviors will include content of communication, timing of communication, and context of communication. This study will seek to accomplish two aims: (1) to identify and describe factors that influence AA fathers’ SRC and (2) to assess the association between AA fathers’ information seeking behaviors and SRC with their 13-17 year old adolescent.

Methods: This study applied a convergent parallel mixed-methods approach. Partnerships were formed with community organizations and businesses to recruit AA fathers of 13-17 year-old adolescents. Participants completed an online quantitative survey assessing informational, motivational, and perceived behavioral skills related to SRC. In-depth interviews were conducted with a subset of fathers to gain further insight on factors that may contribute to AA fathers’ SRC behaviors. Both the in-depth interview and quantitative survey were guided by constructs from the Information, Motivation, and Behavior Skills Model and the Theory of Motivated Information Management. Quantitative and qualitative data were collected during a single phase of the research study, analyzed separately, and interpreted together to understand where the data converged and diverged.

Results: From February 2021-May 2022, a total of 101 African American fathers completed the online survey, and 20 African American fathers completed an in-depth interview through video-conferencing software. The majority of participants had greater than a high school education (86% on survey and 90% in interviews), were employed (91% on survey and 100% in interviews), and were married (93% on survey and 85% in interviews). A large proportion of participants reside in the state of Georgia (58% on survey and 75% in interviews). Overall, participants reported discussing at least one SRC topic with their adolescent (94% on the survey and 90% in interviews). Participants discussed a variety of sexual risk related topics such as abstinence, how to know when you’re ready to have sex, sexual intercourse, using a condom, birth control, getting pregnant, the dangers of have multiple sex partners, and STIs and HIV. On average, participants discussed at least 8 topics related to sex. The average age fathers initiated SRC with their adolescent was 12 years old. Father education was associated with the number of topics discussed and frequency of attendance at worship services was associated with the age at which SRC was initiated. While black fathers discussed several sexual risk-related topics with their adolescents, interviews revealed that there are opportunities to increase their knowledge of sexual risk prevention and reproduction. Additionally, fathers reported engaging in both direct and indirect information seeking on the survey and in the interviews.

Implications: This work has several implications for public health policy, research, and practice. First, the results from this study underscore the need to assess AA fathers’ knowledge of specific sexual risk prevention and reproduction facts. Additionally, it is important for future work to explore the use of communication theories to understand the process of father-adolescent SRC. Implications for practice include the need for medical providers to incorporate parents in their education of adolescents regarding puberty and sexual risk reduction. Practice implications include ensuring parents are incorporated in in adolescent sexual risk reduction programming. Policy implications include the support of legislation proposing comprehensive sexual health education that include a parental component. These steps would help to provide consistent and constant sexual risk prevention messaging for adolescents from multiple sources as well as provide fathers with resources to aid in SRC with their adolescent.

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