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For the final paper you will use my newspaper article you will see that attatchment titled (MAIN) and 1 empirical article titled (EXTRAS)  as your main comparison to the newspaper article. The other additional articles can  be used in your introduction and conclusion sections, but only 1 empirical article will be compared to the news article.

ii. The paper should include an abstract that briefly describes the contents of your paper, an introductory section that describes the general research topic with cited and referenced sources and summarizes the newspaper article. In the next section the empirical article you have chosen will be summarized and reviewed. The concluding section should compare and contrast the information in your newspaper and empirical articles and refer back to the general topic. Be sure to evaluate the quality of the newspaper article in light of what you read in the scientific article. The paper is to be about

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30 of 343 DOCUMENTS The New York Times January 11, 2017 Wednesday 00:00 EST Talking With Both Daughters and Sons About Sex; Adolescence BYLINE: LISA DAMOUR SECTION: WELL; family LENGTH: 1118 words HIGHLIGHT: When parents talk about sex with their teenagers, they tend to view boys as playing offense and girls playing defense. Parents play a key role in shaping sexual decision-making among adolescents – especially for girls. A 2016 review of more than three decades of research found that teenagers who communicated with their parents about sex used safer sexual practices. Likewise, new research from Dutch investigators who studied nearly 3,000 teenagers found that young adolescents who reported feeling close with a parent were unlikely to have had sex when surveyed again two years later. Notably, both research teams found that daughters benefited more than sons, and that the effective conversations and relationships were typically had with mothers. According to Laura Widman, lead author of the review study and an assistant professor of psychology at North Carolina State University, “parents tend to talk about sex more with daughters than with sons, and we can speculate that that’s what’s probably driving these findings. Boys may not get the messages as frequently or have the kind of in-depth conversations that parents are having with girls.” Given the results of her research, Dr. Widman said that she “wouldn’t want parents to get the idea that they only need to talk to daughters. In fact, it may be the opposite. We need to find a way to help parents do a better job of communicating with both their sons and daughters so that all teens are making safer sexual decisions.” That parents have more frequent conversations with their daughters about sex and sexual development may be prompted by biological realities. Menstruation, HPV vaccination (which remains more common in girls than boys), and the fact that birth control pills require a prescription might spur discussions that aren’t being had with sons. Yet experts also agree that gender stereotypes play a powerful role in sidelining both fathers and sons when it comes to conversations about emotional and physical intimacy. Andrew Smiler, a psychologist who specializes in male sexual development, noted that women generally “have a better vocabulary for talking about feelings and relationships than boys and men do. Fathers may be a little more stoic, more reserved and more hands-off.” And, he added, “they may play Page 1 to the stereotype of trusting boys to be independent and able to care for themselves.” These same stereotypes can also tend to steer the conversation in one direction with daughters and another direction with sons. When parents do address sexual topics with their teenagers, they typically adopt a heterosexual frame with boys playing offense and girls playing defense. “We usually view our girls as potential victims who need to be protected from pregnancy and rape,” says Sheryl Ziegler, a psychologist who provides mother-daughter seminars on puberty and sexual development, while boys are often cast as testosterone-fueled prowlers looking for nothing but sex. These assumptions often drive how parents approach the conversation. Dr. Mary Ott, an associate professor of pediatrics at Indiana University and the author of a research synopsis on sexual development in adolescent boys observed that, “when parents talk with boys, there’s an assumption that they’ll have sex and they are advised to use condoms. Whereas for girls, there’s more of a focus on abstinence and delaying sex.” Parental concern about the negative consequences of adolescent sexual activity can reduce “the talk” to a laundry list of don’ts. Don’t get a sexually transmitted infection, don’t get pregnant or get a girl pregnant and don’t proceed without gaining consent. Critical as these topics are, Dr. Ziegler points out that they can “become the focus, so much more than having a quality conversation about why we are sexual beings, or talking about all of the ways we can express love.” And failing to acknowledge the pleasurable side of sex can, according to Dr. Smiler, hurt the credibility of adults. “When parents only acknowledge the scary side of the story,” he said, “teenagers can devalue everything else the parents have to say.” So how might we do justice to conversations with both our daughters and sons about emotional and physical intimacy? Over the years in my work as a clinician, I’ve come to a single tack that I take with adolescent girls and boys alike. First, I prompt teenagers to reflect on what they want out of the sexual side of their romantic life, whenever it begins. Why are they being physically intimate, what would they like to have happen, what would feel good? Following that, I encourage each teenager to learn about what his or her partner wants. I urge them to secure not just consent, but enthusiastic agreement. Given that we also grant consent for root canals, gaining mere permission seems, to me, an awfully low bar for what should be the joys of physical sexuality. Dr. Smiler adds that any conversation about consent should avoid gender stereotypes and address the fact that boys experience sexual coercion and assault and “include the idea that boys can and do say no.” Finally, if the parties are enthusiastically agreeing to sexual activity that comes with risks – pregnancy, infection, the potential for heartbreak, and so on – they need to work together to address those hazards. Research suggests that this shouldn’t be a single sit-down. The more charged the topic, the better it is served, and digested, in small bites. Further, returning to the topic over time allows parents to account for the rapidly shifting landscape of adolescent sexual activity. We should probably be having one conversation with a 12-year-old, an age when intercourse is rare, and a different one with a 17-year-old, half of whose peers have had sex. Is it better for mom or dad to handle these discussions? Teenagers “want to have the conversation with someone they trust and respect and who will show respect back to the teen,” Dr. Smiler said. “Those issues are more important than the sex of the person having the conversation.” How families talk with teenagers about their developing sexuality will reflect the parents’ values and experiences but, Dr. Ott notes, we’re all in the business of raising sexually healthy adults. “We want our teenagers to develop meaningful relationships and we want them to experience intimacy,” she said, “so Page 2 Talking With Both Daughters and Sons About Sex; Adolescence The New York Times January 11, 2017 Wednesday 00:00 EST we need to move our conversations about sex away from sex as a risk factor category and toward sex as part of healthy development.” And we need to do so with our sons as well as our daughters. Lisa Damour (@LDamour) is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” LOAD-DATE: January 12, 2017 LANGUAGE: ENGLISH DOCUMENT-TYPE: News PUBLICATION-TYPE: Web Blog Copyright 2017 The New York Times Company All Rights Reserved Page 3 Talking With Both Daughters and Sons About Sex; Adolescence The New York Times January 11, 2017 Wednesday 00:00 EST
– 1 – INTRODUCTION Recent data indicated that in 2012, there were 309,060 pregnancies in the United States (US) among teenagers between the ages of 15 to 19 years (rate: 29.4 per 1,000). This was a reduction from 329,797 (rate: 31.3 per 1,000) in 2011 (Martin, Hamilton, Osterman, Curtin, & Mathews, 2013). Even though there was a reduction of teen birth rates, where teen births accounted for less than 8% of all registered births in the United States (CDC, 2013), adolescent pregnancy continues to be considered a major prob – lem in the US. Teens in the US are between two to ten times more likely to give birth compared to other developed and European nations (Kearney & Levine, 2012). Within the US, rates vary by state. In South Carolina for adolescents aged 15 to 19 years, teen birth rates are 44.6 per 1,000 live births, which is higher than the national average of 39.1 per 1,000 live births (South Carolina Department of Health and Environmental Control [SCDHEC], 2012). Among non-white teens in South Carolina, these rates are even higher, with 48.6 per 1,000 live births (SCDHEC, 2012). Teens that become pregnant may have bleak future expectations. Teen girls who be – come pregnant may have to drop out of school and as a consequence, with limited education and skills, may have limited career opportunities and reduced earning power (World Health Organization [WHO] 1, 2014; WHO 2, 2014; Kearney & Levine, 2012; Domencio & Jones, 2007). Teen mothers also tend to be part of a welfare system, putting a strain on so – cial services (Thompson, Bender, Lewis, & Watkins et al. 2008). Studies have linked teen pregnancy to fam – ily discord or disruption (Silk & Romero, 2014; Thompson, 2008). Conversely, youth that have co – hesive family environments, where there is parent- child connectedness, reduce risky sexual behaviors (Silk & Romero, 2014) or are less likely to take sexu – al risks when they perceive their parents to be warm and knowledgeable (Rodgers & McGuire 2012). Other contributing factors include mother’s early age at first sex or at first birth, older sibling’s early sexual behavior, physical abuse, (Silk & Romero, 2014), en – gagement in delinquent behaviors, (Thompson, et al. 2008) and household substance abuse such as drug and alcohol use (Silk & Romero, 2014; Thomp – son, et al. 2008). Studies have also found that teen pregnancy may be as a result of potential coerced sexual intercourse (Kearney & Levine, 2012; Rod – gers & McGuire, 2012) and the inability to access birth control (Kearney & Levine, 2012; Domencio & Jones, 2007). There is an intersection between social-ecologi – cal factors such as race, poverty and teen pregnancy (Silk & Romero, 2014). The two most prevalent contributing factors for risky sexual behaviors are poverty (Silk & Romero, 2014; Kearney & Levine, 2012) and single parent households (Kearney & Levine, 2012; Rodgers and McGuire, 2012). For example, Thompson et al., (2008) found that teens who lived in two-parent households were less likely to be pregnant. Children living in poverty may live Abstract:The purpose of this study was to assess parents’ and teens’ views on talking about sex and birth control and their level of comfort in discussing these topics. The methodology consisted of telephone surveys with 988 adults and in person interviews with 797 teens within two counties in South Carolina. This study found that more teen females than males communicated with adults about discussing sex or birth control and mothers were most likely to be sought out. Over half of the teens indicated that they had talked to another adult abo ut sex or birth control and the person most likely sought out was an adult friend. Most parents agreed that they talk openly with their teens about waiting to have sex as well as using condoms and other birth control. Simi – larly, most parents reported they felt very comfortable talking to teens about sex or birth control with women and African-Americans reporting greater comfort. Teens indicated that they felt very comfortable talking with their parents about sex, with African American females and White males reporting more comfort than White females. These results may indicate that teens are interested in seeking sexual health information from parents, including adult friends. Adults’ willingness to engage in these topics with teens is vitally important. In our study, racial and gender differences were found in comfort level of both parents and teens talking about sex. Key Words: Sexual Communication, Adults, Teens, Birth Control Let’s talk about sex: Parents’ and teens’ comfort levels during tfese discussions Sharon H. Thompson, Ed.D. John F. Yannessa, Ph.D. Fredanna M. McGough, Ph.D. Michael S. Dunn, Ph.D. Jennifer L. Duffy, Ph.D. Sharon H. Thompson, Ed.D. Professor Department of Health Sciences Coastal Carolina University John F. Yannessa, Ph.D. Associate Professor Department of Health Sciences Coastal Carolina University Fredanna M. McGough, Ph.D. Associate Professor Department of Health Sciences Coastal Carolina University Michael S. Dunn, Ph.D. Associate Professor Department of Health Sciences Coastal Carolina University Jennifer L. Duffy, Ph.D. The South Carolina Campaign to Prevent Teen Pregnancy Thompson, Yannessa, McGough – 2 – in unstable conditions and possible sustained fam – ily discord (Thompson, et al. 2008). Silk & Romero (2014) purport that poverty reduction policies are antecedents of teen pregnancy (2014). Contrary to previous research, however, Rodgers and McGuire (2012) found that poverty was not associated with sexual onset, having multiple sexual partners or pregnancy when accounting for demographic, vio – lence experiences and parenting behaviors. It must be noted however, that poverty was addressed at the community level and not individually or by family. Socio-ecological factors can be both predispos – ing and consequential of teen pregnancies. A World Health Organization (WHO) report found that pregnancies to unmarried adolescents were more likely to be unintended and may end in induced abortions (2014). In addition, pregnant teens, par – ticularly younger ones, may be more susceptible to negative health factors and be affected by pregnancy- related complications such as stillbirths, infant mor – tality, and low birth weight babies (WHO, 2014; Thompson, et al. 2008). Recent studies support the notion that the is – sue of teen pregnancy should include parental in – tervention (Silk & Romero, 2014). A study about parental communication with teens in Mexico found that with parental understanding of communication about sex and sexuality, they were better able to com – municate safe sex messages, such as correct condom use, emergency contraception and STI swith their teens (Campero, Walker, Rouvier, & Atienzo, 2010). Parent-child communication about sex and the use of condoms or contraceptives before initiation, parental disapproval of premarital sex, parental acceptance and support of contraceptive use for sexually active teens, parental supervision and monitoring, fam – ily connectedness and satisfaction with relationship are all characteristics that have shown that the onset of sexual activity can be delayed (Silk & Romero, 2014). Higher paternal connectedness, teen-parent attachment and quality of communication caused a delay in initiating sex in adolescents and decreased sexual behavior (Silk & Romero, 2014; Guilamo- Ramos et al, 2012). Studies have found that the influence of moth – ers can delay a girl’s initiation of sexual activity (Wight & Fullerton, 2013). To facilitate parental ability to communicate effectively with their teens, programs that have an intense parenting element can be instrumental as these have been found to reduce teen sexual activity and risk behaviors (Wight & Ful – lerton, 2013). Parents and their teens have reported that dis – cussions about sex and birth control are uncomfort – able although it is not the case when parents have conversations about boyfriend and girlfriend infor – mation (Ogle, Glasier, & Riley, 2008). There is of – ten discomfort with initiating a conversation about sex,because parents do not know how to address the topic and fear and embarrassment make it taboo to discuss sexual topics (Campero, Walker, Rouvier, & Atienzo, 2010; Ogle, 2008) particularly on the part of fathers (Wight & Fullerton, 2013; Ogle et al., 2008; Eisenberg, Sieving, Bearinger, & Swain, 2006). These feelings are reciprocated by the teens (Campero, Walker, Rouvier, & Atienzo, 2010; Ogle, Glasier, & Riley, 2008). Researchers have previously found that although boys are slightly more comfort – able talking to either parent than girls are, girls are more likely to talk to their mothers than their fathers about sex and birth control (Ogle et al., 2008). Studies have found that conversations between parents and their teens are often delayed. The con – versations often time are only initiated after the par – ents perceive their teen to be in a romantic relation – ship. For example, Eisenberg et al. (2006) found that parents who believe that their teen was romantically involved were more likely to talk to their teen about the impact of sexual intercourse on one’s social life, the consequences of pregnancy, and where to obtain condoms and birth control. Hadley et al. (2009) found that parental discussion of condom use was directly related to higher use of condoms and higher rates of protected sex acts among those teens that were sexually active. Conversations with teens have to be specific to sexual health such as condom use because general open communication is not related to consistency of condom use (Hadley et al., 2009). As South Carolina’s teen pregnancy rates are higher than the National rates, particularly among minority (African American and Hispanic) popula – tions, it is important to explore possible protective factors, specifically parent and teen communication. Considering that studies have found that specific parent and child sexual health communication can influence sexual health behaviors, it is important to examine to what extent these conversations are tak – ing place in South Carolinian households and iden – tify where the biggest communication gaps exist to be addressed. The current research assesses parental and adolescent perceptions regarding communicat – ing about sexual behaviors, sex knowledge and birth control, and their level of comfort in discussing these topics. METHODS The Centers for Disease Control and Prevention and the US Department of Health and Human Ser – vices’ Office of Adolescent Health funded the South Carolina Campaign to Prevent Teen Pregnancy (SC Campaign) to develop teen pregnancy preven – tion initiatives in two counties in the state of South Carolina (CDC, 2013). As a part of these President’s Teen Pregnancy Prevention Initiatives, two popula – tions were surveyed. First, telephone surveys were conducted with adults; second, interviews were conducted with teens by trained teens. This paper is based on secondary analyses conducted using these data sets. Adults and teens in this study came from the same two counties, but were not necessarily in the same families. Adult Sample Procedure and Participants Telephone surveys were conducted to collect in – American Journal of Health Studies Vol 30 (1) 2015 – 3 – formation on perceptions of teen pregnancy among adult residents in two counties in South Carolina. The survey design was cross sectional in nature. Both counties are similar in terms of population size, ra – cial and gender characteristics, educational level, so – cioeconomic status and teen pregnancy rates. One county is located on the east coast and is bounded on the north by the North Carolina state line. The county encompasses 1,134 square miles and boasts a population of more than 196,000. The other county is nestled in the foothills of the Blue Ridge Moun – tain between Atlanta, Georgia and Charlotte, North Carolina. The county encompasses 811 square miles and a population of more than 286,000 (US Cen – sus Bureau, 2010). Respondents were selected using a dual sampling frame approach, one being a ran – dom sample of landline telephone exchanges and the second being a random selection of cell phone ex – changes. When contact was made with a residential phone number or cell phone number, the interviewer screened participants to ensure they met the eligibil – ity criteria (over the age of 18 and a resident of one of the two target counties). If more than one adult over the age of 18 lived at the residence, a respondent was randomly selected. Parents of children between the ages of 10 and 19 were oversampled. Interviews were conducted using computer- aided telephone interviewing by staff of the Institute for Public Service and Policy Research at the Univer – sity of South Carolina. The survey took place from March through May 2011. A total 988 adults in two counties participated in the survey, including 526 parents of a child aged 15-19. The overall response rate was 30%. Although this response rate may seem low, a Pew Research study found that telephone sur – vey response rates have dropped to an average of 9% in 2012 compared to 25% a decade ago (Pew Re – search, 2012). Teen Sample Procedure Philliber Research Associates (PRA) served as consultants to the SC Campaign to develop and ad – minister a survey in the same two South Carolina counties used for the adult survey (described in pre – vious section) using a process where youth adminis – tered the survey to other youth. The survey design was cross sectional in nature. This first step in this process for the teen survey was eliciting ideas from community stakeholders attending public meetings about what topical areas should be explored. Feed – back from these meetings, paired with input from SC Campaign staff, formed the basis of the survey questions developed by PRA. Teens from each coun – ty were recruited and trained to conduct the survey in February 2011. The areas within each of the two counties which had the highest density of births to adolescents aged 15-19 were selected to administer the survey. Streets within these areas were randomly selected and teams of interviewers were sent to those streets. Each household on the street was screened to determine if adolescents between the ages of fifteen and nineteen lived there. Under the supervision of Philliber Re – search Associates, these teens interviewed 797 teens in the population centers in each participating coun – ty. In the first county, a total of 1,587 households were screened. There were 488 eligible teenagers liv – ing in these households and 397, or 81%, completed a survey. Using this process in a second county, a to – tal of 2,411 households were screened. There were 478 eligible teenagers living in these households and 400, or 84%, completed a survey. Survey procedures were designed to ensure con – fidentiality. Participants’ names were never associated with their responses and the teens collecting surveys never saw their responses. Eligible adolescents were provided a $25 incentive to complete the survey. Sur – veys were completed only when youth over 18 pro – vided informed consent, or youth younger than 18 who assented and whose parents provided informed consent. This research protocol was approved by an external institutional review board (Liberty IRB) prior to data collection. Measures and Data Analysis for Adult Sample The surveys for both adults and teens consisted of multiple questions designed to measure attitudes and beliefs surround the issue of teen pregnancy in South Caroline. The analysis questions from the two surveys were identified based on the purpose of the study which was to assesses parental and adolescent perceptions regarding communicating about sexual behaviors, sex knowledge and birth control and their level of comfort in discussing these topics. Demographic information was obtained for race, gender, and parental status (parent or non-par – ent). Most respondents (93.2%) were either White or African American; therefore, only those in these two racial categories were included in the data analy – sis. Frequencies were run by parental status (parent vs. non-parent) for gender and race. Chi-square analyses were conducted to deter – mine categorical differences between parents and non-parents for beliefs and social norms about com – munication with teens about sex and birth control. The Likert-type scale had 5 points ranging from agree strongly, agree somewhat, disagree somewhat, disagree strongly, to don’t know. For ease of compari – sons and to avoid small cell sizes for the Chi-square analyses, the responses for “agree strongly” or “agree somewhat” were collapsed together as “agree” and those for “disagree somewhat” or “disagree strongly” were collapsed as “disagree”. “Don’t know” responses were removed from this analysis. A p-value of <.05 was used for statistical significance. Two survey items rated parents on communica – tion with their teen or pre-teen on 1) sex and 2) birth control and 4-point Likert-type scales were used (1 = agree strongly; 4 = disagree strongly) as well as a “don’t know” response. Those answering “don’t know” were removed from this analysis. Two simi – lar items asked about parents’ comfort level talking to teens or pre-teens about 1) sex or 2) birth control with different 4-point Likert-scales (1 = very comfortable; Thompson, Yannessa, McGough – 4 – 4 = not at all comfortable) as well as a “don’t know” response. Similar to above, those responding “don’t know” were removed from this analysis also. These results were first analyzed with frequencies and later using the General Linear Model Analysis of Variance. Comfort levels (dependent variables) were examined by categorical independent variables: race (African American or White) and gender. The model was first run with interaction terms for the independent variables and if these were not significant they were removed and the model was re-analyzed. A probabil – ity value of <.05 was required for differences between groups to be considered statistically significant. Measures and Data Analysis for Teen Sample Similar to the parents, most teens were either African American or White, so those who reported being of other races were not included in analyses. Race and gender were reported using frequencies. T- tests were used to examine differences in the teens’ ages by gender; a p-value of .05 used for statistical significance. The teens were asked several items related to sex and birth control communication. These questions were worded by the SC Campaign to use both sex and birth control together in the items; therefore these items were examined statistically in this way. These items and allowed responses included: 1) Have you ever talked to a parent about sex or birth control? (Yes/No); 2) For those responding yes to #1, Which parent have you talked to about sex or birth control? (Mom/Dad); 3) Have you ever talked to another adult about sex or birth control? (Yes/No); 4) For respond – ing yes to #3, Which adults have you talked to about sex or birth control? (a number of responses were pro – vided and teens could select all that applied), 5) If you wanted information about sex or birth control, which of the following would you choose? [8 responses (mother, father, brother/sister, friend, teacher, religious leader, health care provider, internet, media) and an “other” response was provided for this item and teens could choose more than one response], and 6) How com – fortable are you talking to your parents about sex or birth control? (1- somewhat comfortable; 4-not at all comfortable) . Frequencies for all participants and by gender were run for these 6 items. In order to de – termine differences by gender categories, Chi-square tests were run for items #1-3 and #5, listed above. The General Linear Model Analysis of Vari – ance was used to determine teens’ comfort level (de – pendent variables) in talking to parents about sex and birth control by the categorical independent variables of race (African American or White) and gender. The model was first run with interaction terms and if these were significant the alpha value was adjusted using the Bonferroni method to adjust for type I errors (p = .05 / number of comparisons). Otherwise, a probability value of <.05 was required for differences between groups to be considered sta – tistically significant. RESULTS Most adults (n=921) were parents (52.4%, n=483), female (65.7%, n=605), and White (82.1%, N % N % Gender Male 149 30.8% 167 38.3% Female 334 69.1% 271 61.9% Race African American 98 20.3% 67 15.3% White 385 79.7% 371 84.7% Characteristic Adults Parent (n = 483), n= 52.4% Non-Parent (n = 438), n = 47.6% Teens N % Gender Male 366 57.1% Female 275 42.9% Race African American 215 33.5% White 426 66.5% Mean Ages SD Male 16.99 years 1.67* Female 16.73 years 1.52 *p = .0459. Table 1. Demographic information for adult (n=921) and teen respondents (n = 641). American Journal of Health Studies Vol 30 (1) 2015 – 5 – n=756). Among teen respondents most were male (57.1%, n=366) and White (66.46%, n=426). T- tests revealed significant differences by age with males older (M = 16.99 years, SD = 1.67, p = .046) than females (M = 16.73 years) (see Table 1 for de – mographic information). When adults were asked about beliefs and social norms related to sex and birth control use by teens, chi-square tests revealed differences in categories with 73.06% of parents and 59.76% of non-parents “strongly ” or “ somewhat ” agreeing that most parents talk openly with their teens or pre-teens about waiting to have sex [x2 (1, n = 930) = 22.68, p < .0001] (see Table 2 for adult’s beliefs about social norms). Cat – egories were also significantly different for the survey item: Most parents in your community talk openly with their teens or pre-teens about using condoms or other birth control methods (Parents: 67.4% agree strong – ly/somewhat; Non-parents: 57.7% agree strongly/ somewhat) [x2 (1, n = 845) = 8.94, p = .003]. In contrast, a majority of both parents and non-parents indicated that most parents should talk openly with their teens about waiting to have sex (98.3% and 98.8% respectively) and using condoms or birth con – trol methods (93.7% and 92.1% respectively). There were no significant differences for these two items when comparing parents vs. non-parents. Survey Item % agree strongly or agree somewhat Parents Non-Parents n % N % Most parents talk openly with their teens or pre-teens about waiting to have sex. 336 73.0% 253 59.7%* You think most parents in your commu – nity should talk openly with their teens or pre-teens about waiting to have sex. 474 98.3% 427 98.8% Most parents in your community talk openly with their teens or pre-teens about using condoms or other birth control methods. 291 67.4% 216 57.7%** You think most parents should talk openly with their teens or pre-teens about using condoms or birth control methods. 449 93.7% 395 92.1% Table 2. Parents vs. non-parents beliefs and social norms related to teens waiting to have sex and using birth control. Note: Chi-square analyses performed comparing parents/non-parents for those who somewhat agree/strongly agree vs. somewhat disagree/strongly disagree.*[x2 (1, n = 930) = 22.68, p < .0001].** [x2 (1, n = 845) = 8.94, p = .003]. Survey results for teens related to communica – tion with adults on sex or birth control were then examined by gender and are presented in Table 3. When asked, Have you talked to a parent about sex or birth control? , categories were different by gen – der. Most males (54.47%) and females (75.53%) answered yes [x2 (1, n = 630) = 24.01, p < .0001]. Those who responded “yes” to the previous ques – tion were then asked, Which parent have you talked to about sex or birth control? Responses were highest for “ mom ” at 82% with 72% of males and 92% of females selecting this response. A higher percent – age of males (65%) than females (20%) noted they had talked to their “ dad ” about sex or birth control. When teens were asked if they had ever talked to an – other adult about sex or birth control , 52.4% respond – ed “ yes” with significant differences between the genders (Yes response females: 58.3%; Yes response males: 48.0%) [x2 (1, n=631) = 6.5, p = .0107]. For those who answered “yes”, the three highest percent – ages found for talking to adults about sex or birth control included: Friend 69%, Teacher 29%, and Health Care Professional 27%. Thompson, Yannessa, McGough – 6 – All teens Male Female Have you talked to a parent about sex or birth control? YES 62.7% n=395 54.5% n=195 73.5%* n=200 NO 37.3% n= 235 45.5% n=163 27.5% n=72 Which parent(s) have you talked to about sex or birth control? Mom 82% n=326 72% n=141 92% n=185 Dad 42% n=166 65% n=126 20% n=40 Have you ever talked to another adult about sex or birth control? YES 52.5% n=331 48.1% n=173 58.3%** n=158 NO 47.5% n=300 51.9% n=187 41.7% n=113 Which adults have you talked to another about sex or birth control? (participants could select all that applied) Friend 69% n=229 72% n=124 66% n=105 Teacher 29% n=97 37% n=64 22% n=34 Health Care Professional 27% n=91 20% n=35 35% n=56 Religious Leader 18% n=59 19% n=33 16% n=26 Other 14% n=47 17% n=30 11% n=17 Table 3. Communication by teens with parents and other adults related to sex or birth control by gender (n=630). *[x2 (1, n = 630) = 24.01, p < .0001]. ** [x2 (1, n=631) = 6.5, p = .0107]. Teens were asked, “If you wanted information about sex or birth control, which of the following would you use?” (see Table 4 for answers to this survey item). The top 3 percentages for all teens were: Mom (78%), Dad (48%) and Friend (47%). These were also the top 3 percentages for males; however, fe – males had the following top responses: Mom (82%), Doctor (51%), and Friend (50%). Note that the teens could select more than one response for this item; therefore, responses do not add up to 100%. American Journal of Health Studies Vol 30 (1) 2015 – 7 – All teens Male Female Mom 78% n=490 74% n=265 82% n=225 Dad 48% n=300 63% n=225 28% n=75 Friend 47% n=297 45% n=161 50% n=136 Doctor 41% n=250 31% n=111 51% n=139 Brother or Sister 38% n=240 42% n=149 33% n=91 Internet 30% n=188 30% n=108 29% n=80 Teacher 28% n=178 29% n=103 28% n=75 Religious Leader 19% n=121 20% n=71 18% n=50 Media 14% n=86 16% n=58 10% n=28 Other 4% n=28 5% n=18 4% n=10 Table 4. Responses for all teens and by gender for the question, “If you wanted information about sex or birth control, which of the following would you use?” (n=630).* * Teen respondents could choose more than one response for this question. When parents were asked if they talk openly with their teens or pre-teens about waiting to have sex as well as using condoms or other birth control methods , most responded “ agree strongly ” for these survey items (see Table 6). Similarly, most parents reported they felt very comfortable talking to teens about sex or sexual in – tercourse (62.0%) or talking to them about condoms or birth control (59.4%) (see Table 5 for results on parent’s discussions on these topics). Table 5. Parents’ responses related to communication and comfort level in discussing sex, waiting to have sex and using birth control with their teens or pre-teens. Agree strongly Agree somewhat Disagree some – what Disagree strongly You talk openly with your teen or preteen about waiting to have sex. 89.2% n = 431 9.1% n = 44 1.0% n = 5 0.1% n = 3 You talk openly with your teen or pre-teen about using condoms or birth control methods. 66.5% n = 320 18.5% n = 89 6.7% n = 32 8.3% n = 40 Very comfortable Somewhat com – fortable Not very com – fortable Not comfortable at all How comfortable are you talking with your teen or pre-teen about sex or sexual inter – course? 62.0% n = 299 31.5% n = 152 5.2% n = 25 1.2% n = 6 How comfortable are you talking with your teen or pre-teen about condoms or birth con – trol methods? 59.4% n = 285 29.2% n = 140 8.8% n = 42 2.7% n = 13 Note: Those responding “don’t know” were removed from data analysis. Thompson, Yannessa, McGough – 8 – When teens were asked their comfort level in talking with their parents about sex or birth control, 44.27% said they felt very comfortable. Results for the teens’ responses on comfort level when discuss – ing sex with parents are found in Table 6. Very com – fortable Somewhat comfortable Not very comfortable Not at all comfortable How comfortable are you talking to your parents about sex or birth control? All teens 44.3% n = 278 28.2% n = 177 16.1% n = 101 11.5% n = 72 Males 46.1% 28.5% 15.1% 10.3% Females 43.6% 26.7% 16.9% 12.8% Table 6. Teens’ responses related to comfort level in discussing sex or birth control with their parents by gender (n= 628). Note: 1 = Very comfortable; 4 = not at all comfortable Adults’ comfort level in talking about sex and birth control with teens/pre-teens. When analyzing respons – es for the statement, “How comfortable are you talk – ing with your teen or pre-teen about sex?” , the General Linear Model Analysis of Variance was performed with race and gender as independent variables (see Table 8). Women (M = 1.33) reported more com – fort in talking with their children about sex (1= very comfortable; 4=not comfortable at all) than men (M = 1.58, p < .0001). Racial differences were found as well with African Americans (M = 1.38) reporting more comfort than Whites (M = 1.52, p = .0374). When a similar question was asked to adults about comfort talking to teens or pre-teens about birth control, similar findings were revealed with females feeling more comfort (M = 1.36) than males (M = 1.71, p < .0001). African Americans felt more com – fort (M = 1.41) than Whites (M = 1.66, p = .0032). Teen’s comfort level in talking about sex and birth control with parents. When asked, “How comfortable are you talking with your parent about sex or birth con – trol?” , there were no significant differences found by race or gender; however, there was a significant in – teraction found between race and gender. Multiple comparisons were performed and in order to reduce the chances of obtaining type I errors, the Bonferroni method for modifying the p-value was used. For this the p < .05 alpha level was adjusted by the number of comparisons made (p-value of .05 / 4 = adjusted p-value of .0125). There were significant differences between White males’ (M = 1.8) and White females’ (M = 2.12) responses with the White females report – ing significantly lower comfort levels talking to par – ents about sex than males (p = .0017). White females also had significantly lower comfort levels discussing sex and birth control with parents (M = 2.12) than African American females (M = 1.72, p = .0022) (see Table 7). American Journal of Health Studies Vol 30 (1) 2015 – 9 – p-value M SD PARENTS How comfortable are you talking to your teen or pre-teen about sex? GENDER p < .0001 Male 1.58 1.27 Female 1.33 .89 RACE p = .0374 African American 1.38 1.47 White 1.53 .74 How comfortable are you talking to your teen or pre-teen about birth control? GENDER p < .0001 Male 1.71 1.47 Female 1.36 1.03 RACE p = .0032 African American 1.41 1.69 White 1.66 .876 TEENS How comfortable are you talking with your parent about sex or birth control? GENDER p = .8784 Male 1.93 1.46 Female 1.92 1.65 RACE p = .4046 African American 1.89 1.76 White 1.96 1.27 RACE*GENDER * White male*White female p = .0017 1.80 / 2.12 White female*African American female p = .0022 2.12 / 1.72 Table 7. Parents’ (n = 482) and teens’ (n=617) comfort level in talking about sex and birth control (1 = very comfortable: 4=not comfortable at all). *General Linear Model Analysis of Variance was used for statistical analysis. Bonferonni corrections were used to adjust p-values for significant interaction – adjusted for number of comparisons: p<.05 / 4 = p < .0125 for statistical significance. Note: 1 = very comfortable; 4 –=not at all comfortable DISCUSSION These results are important when inform – ing the ongoing national discussion regarding sexual health education and perceptions of its need. Part of the national conversation among community mem – bers and public health professionals alike is discov – ering community comfort level in discussing sexual health information, gaining a greater understanding of the various parties initiating these discussions, and understanding the best avenues to engaging parents, educators, and male and female pre-teens and teens in the conversation. Historical research has documented the impor – tance of family involvement when discussing sexual health information (Gordon, 1973; Gordon, 1975). More recent research has documented that there is often discomfort with initiating a conversation about sex, particularly on the part of fathers (Wight & Fullerton, 2013; Ogle et al., 2008; Eisenberg et al., 2006). These feelings are often reciprocated by the teens, where they are also uncomfortable discuss – ing sexual issues with their parents. While past re – searchers (Ogle et al., 2008) have found that discus – sions about sex and birth control are uncomfortable, it appears that in this sample that most of the adults seemed to think that conversations between adults, pre-teens and teens regarding sexual health informa – tion were open, encouraged, and supported within their communities. For example, the adults in this sample indicated that they agreed that most parents do talk openly with pre-teens and teens about wait – ing to have sex and using condoms and birth control, Thompson, Yannessa, McGough – 10 – and that parents should talk openly with pre-teens and teens about these topics. While this perceived openness may seem surprising given the conservative reputation of the state of South Carolina (Gallup, 2010), it reinforces recent published data indicating that community dwelling adults value community based sexual health education within a conservative state (Dunn, Thompson, M’Cormack, Yannessa, & Duffy, 2014). The teen perspectives about their behavior rela – tive to seeking sexual health information revealed interesting differences in behavior. Nearly all of the female (92%) teens in this sample reported seeking information about sex or birth control from “mom.” These results support that of previous researchers in indicating the relative importance of a mother in communication of sexual health information (Ogle et al., 2008; Wight & Fullerton, 2013; Wisnieski, Sieving, & Garwick, 2015). Mothers seem to be a primary source of information in our sample, there – fore it is important for health educators to engage and guide them so that accurate information can be delivered. Just as important, it would also help en – sure that the mother is comfortable with the content and presentation of the sexual health information. Public health professionals should also consider that in some regions of the country, socio-ecologic variables such as religiosity may impact sexual health communication efforts. For example, the results of recent research indicate that mothers reporting high – er levels of religiosity were more likely to feel uncom – fortable discussing sexual health issues such as mas – turbation, contraception use (such as condom use), and sexual assault (Farringdon, Holgate, McIntyre, & Bulsara, 2013). A mother’s religiosity was not di – rectly measured here, but the topic seems especially relevant in a southeastern state with a high level of religiosity being a social norm (Gunnoe & Moore, 2002). While not a large proportion, nearly 20 per – cent of all teens in this data set reported speaking to a religious leader to gain sexual health informa – tion. This research adds to the data suggesting that while teens may prefer parents and family members to serve as a primary source of sexual health infor – mation, teens still seek information from those in a religious community. Findings from this study may be used to inform future sexual health promotion interventions for religiously affiliated teens. There were behavioral differences among the male and female teens. For example, while nearly 75 percent of the female teen respondents reported talking to a parent about sex or birth control issues, only slightly more than half of the male teen respon – dents reported talking to a parent about the same issues. When asked if they talked to another adult about these issues, the response was still less than half of the males, while their female counterparts were higher. Further, when considering whom the male teen was talking to about sexual health infor – mation, it was most often a friend. Unfortunately, healthcare workers and teachers were lower on the list. Given the low interaction of the male pre-teens and teens with adults, the male may be left vulner – able to sexual health misinformation from friends and peers in the community regarding sexual health information. It seems especially important for sex educators to engage parents in meaningful dialogue before a male child reaches his teen years so parents are more equipped to discuss romantic and sexual issues. In so doing, the health professional can sup – port teens’ healthy sexual and romantic behaviors. Based on the results we have seen here, health and sex educators should also identify young people lack – ing support and encourage strong relationships with family, including fathers. The behavior of the male teens may be a result of perceived gender norms the teens may have. For example, previous reports suggest that boys and young men are far less likely to access sexual health clinics than girls or young women (Marcell, Matson, Ellen, & Ford, 2011). There are multiple reports in the literature to suggest that young men who con – form to traditional gender norms about masculin – ity are less likely to use condoms consistently and more likely to hold negative attitudes about condom use (Noar & Morokoff, 2002). Conforming to these harmful gender norms relative to beliefs, attitudes, and behaviors have all been well documented in the literature as being determinants of sexual risk tak – ing behavior and negative sexual health outcomes (Kirby & Lepore, 2007). However, past research suggests that not all pre-teens and teens agree with these harmful gender norms (Smiler, 2013). It seems that there may be an opportunity for community members and public health professionals to engage pre-teens, especially boys, in the sexual health edu – cation process before perceived normative behavior regarding sexual health attitudes and beliefs becomes actual sexual health behavior. Finally, these data suggest that White females were less comfortable than their African-American counterparts and White males when talking to par – ents about sex/birth control. There have been mul – tiple reports in the literature that providing sexual health information to adolescents reduces negative outcomes of sexual behaviors (Chin et al. 2012; Jacob, et al., 2012; Kirby, Laris, & Rolleri, 2007; Lindberg & Maddow-Zimet, 2012). Our findings may take these recommendations further, in that not only is it important, but it may be additionally useful to take into consideration the teen’s ethnicity. Given the documented importance of a mother’s in – fluence in delaying a girl’s initiation of sexual activity (Wight & Fullerton, 2013), it may be that health educators should increasingly target sexual health messages to mothers of White pre-teens and teens, given their reticence in seeking out health educa – tion information about sex and birth control. This area is certainly an area of potential future scientific inquiry. LIMITATIONS The findings of this study must also be consid – American Journal of Health Studies Vol 30 (1) 2015 – 11 – ered within the context of several limitations. Adults and teens that did not have land lines or cell phones at the time of this study did not have the opportuni – ty to participate in this research. Also, these findings are from the state of South Carolina, and represent only two large counties in the state. They may not represent the attitudes of all teens and adults living in the state, and should not be generalized to other states in the United States. Finally, this research is limited in terms of ethnic representation, with virtu – ally few teens representing any ethnicity other than White and African American. References Campero, L., Walker, D., Rouvier, M., & Atienzo, E. (2010). First Steps Toward Successful Com – munication About Sexual Health Between Adolescents and Parents in Mexico. 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