J Relig Health DOI 10.1007/s10943-014-9950-z ORIGINAL PAPER
Beliefs About Sex and Parent–Child–Church Sex Communication Among Church-Based African American Youth Erin Moore • Jannette Berkley-Patton • Alexandria Bohn Starlyn Hawes • Carole Bowe-Thompson
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Springer Science+Business Media New York 2014
Abstract Parent–child sex communication has been shown to be protective against sexual risk among African American youth. The current study sought to use the theory of planned behavior as a framework for focus group discussions (N = 54 youth participants aged 12–19 years) to explore church youths’ (a) sex beliefs and values (attitudes), (b) sources and evaluation of sex communication and education (subjective norms), (c) facilitator/barriers to adolescent sexual risk reduction and communication behaviors (perceived behavioral control), and (d) intentions to engage in these behaviors. Additionally, participants identified strategies for consideration in developing tailored parent–child–church sex communication education programs for use in African American churches. Themes suggested both positive and negative attitudes toward premarital sex and parents and churches as key sources of sex education and communication. Strategies to enhance parent–child–church sex communication are discussed in the context of these findings. Keywords
Adolescents African American Church Sexual behavior Sex education
Introduction African American youth are disproportionately at risk for sexually transmitted infections (STIs) and teenage pregnancy. African American youth between 15 and 19 have the
E. Moore (&) Department of Psychology, Stetson University, 421 N. Woodland Blvd. Unit 8281, Deland, FL 32723, USA e-mail: [email protected] J. Berkley-Patton A. Bohn C. Bowe-Thompson Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64110, USA S. Hawes Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA 98195, USA
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highest rates of chlamydia and gonorrhea among all adolescents [Centers for Disease Control and Prevention (CDC), 2013a]. The chlamydia rate among Black females aged 15–19 was more than five times the rate of White females in the same age group, and the gonorrhea rate among Black females in this age group was 15 times the rate of Whites in 2012. Additionally, for Black males in the same age group, the chlamydia and gonorrhea rates were 10 times and 26 times the rates among White males, respectively. African Americans also had the second highest birth rates among adolescent females (Martin et al. 2009). Studies have shown that multiple overlapping personal and social factors contribute to African American youths’ increased sexual risk. Personal factors include reaching puberty at earlier ages than their White counterparts (Parent et al. 2003), having more sex partners than youth of other ethnicities (Ford et al. 2002), and using condoms inconsistently (Bachanas et al. 2002). African American youth are also twice as likely as White and Latino youth to report having sexual intercourse by age 13 (CDC 2004). In fact, one study found that more than half of sexually active African American girls had sex by age 14 (Bachanas et al. 2002). Also, adolescents primarily tend to report peers as a source of information on sexual health topics (Guthrie and Bates 2003). Sexually active peers are a significant social influence on adolescent sex behaviors. Moreover, peer influence is greater when adolescents report less involvement from parents (Whitaker and Miller 2000). Parent–child communication about sex has been found to be a protective factor against sexual risk among African American youth (Aspy et al. 2007; DiClemente et al. 2001; Dittus and Jaccard 2000; Hutchinson and Montgomery 2007; Jaccard and Dittus 2000). Studies have shown that African American youth whose parents engage them in discussions about sex are less likely to engage in sexual activity (DiClemente et al. 2001; Hutchinson and Montgomery 2007). Additionally, sexually active African American youth whose parents talk to them about sex were more likely to use contraception, including condoms (Aspy et al. 2007; Hutchinson and Montgomery 2007). A study with a racially diverse sample indicated that youth prefer for their parents to be a source for their sexual health information, rather than having their school and peers provide this type of information (Somers and Surmann 2004). Additionally, a study with primarily African American youth indicated that participants sought out credible sexual health information from trusted community organizations (Kimmel et al. 2013). Previous research has found that African American parents are more likely to discuss sex and birth control with their adolescent than any other racial or ethnic group (Regnerus 2005). A study by Fay and Yanoff (2000) found that youth prefer that their parents provide them with information about being sexually responsible to avoid consequences of sex, as opposed to merely ‘‘preaching’’ about abstinence. However, parents who are regular churchgoers may be more likely to focus on moral issues related to sex and less likely to discuss birth control when talking to their adolescent child compared to parents who are less frequent churchgoers (Regnerus 2005). The African American church may be an ideal forum for providing sex education with youth, education for parents on how to communicate about sex with youth, and general information about sexual health including prevention of STIs and unwanted pregnancies. For both African American youth and their parents, church is often a central part of their lives, providing them with moral guidance and a social support system (Adimora et al. 2001; Chatters et al. 1998; Giger et al. 2008; Taylor et al. 1999). Moreover, up to 80 % of African Americans report that religious beliefs are important (Pew Forum 2009), and over half of African Americans attend religious services at least two to four times a month (Barna Group 2007; Pew Forum 2009).
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Several church-based sex education programs have been developed to target African American youth, parents, and/or church leaders (Baldwin et al. 2008; Griffith et al. 2010; Marcus et al. 2004; Merz 1997; Pichon et al. 2012; Sherr and Dyer 2010); yet none have addressed increasing parent–child sex communication in addition to promoting sexual risk reduction among youth through congregational church services and relevant ministries. One church-based intervention, Taking It to the Pews (TIPS), has focused on communicating about HIV topics (including protective sexual behaviors) and promoting HIV screening in African American churches, particularly with adults (Berkley-Patton et al. 2010, 2012, 2013). Church leaders deliver the religiously and culturally tailored intervention materials and activities from a TIPS HIV Tool Kit during existing church services and ministries (e.g., young adult, women, and outreach). In the formative TIPS research phase, faith leaders participating in focus groups and TIPS meetings requested the development of a youth-oriented arm of the TIPS intervention. They determined that the aims of the TIPS youth intervention [subsequently named TIPS-Youth Promise (TIPS-YP)] should consist of (a) encouraging effective parent–child sex communication through sexual health seminars held separately and jointly with youth and parents; and (b) providing supportive TIPS-YP tools to assist church leaders in delivering religiously youth-tailored materials to promote parent–child sex communication and healthy youth sexual behaviors during church services and youth ministry meetings/events. The current study sought to understand church youths’ (a) sex beliefs and values (attitudes), (b) sources and evaluation of sex communication and education (subjective norms), and (c) facilitator/barriers to adolescent sex behaviors and communication (perceived behavioral control). Additionally, participants identified strategies for consideration in developing tailored parent–child– church sex communication and sexual risk reduction programs for use in African American churches.
Methods Sample Fifty-four African American adolescents completed surveys and participated in focus groups. Participants aged 12–19 years were recruited through church announcements made at 11 African American churches participating in the TIPS-YP project, a church-based HIV testing initiative coordinated by Calvary Community Outreach Network in the Kansas City metropolitan area. Consented participants were served a meal and compensated $5 for their participation. All aspects of this voluntary study were reviewed and approved by the university’s Institutional Review Board. Procedure Seven focus group discussions were held at an African American church. After providing parental and youth informed consent, youth completed a 10-min survey on parent–child communication and religious and sexual behaviors. The youth then participated in focus group discussions that ranged in time from 80 to 90 min. Youth selected pseudonyms to use during the focus groups to support confidentiality. Focus group discussions were led by trained facilitators and were digitally recorded and transcribed.
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Survey Measures The survey consisted of demographic questions including age, sex, sexual orientation, relationship status, church denomination, and history of sexual experience (e.g., ever oral, vaginal, or anal sex; frequency of condom use). Participants were asked how often over the past year they had thought of God, prayed, meditated, attended a worship service, read– studied scriptures/holy writings, and had direct experiences with God on a 4-point Likert scale from ‘‘rarely’’ to ‘‘daily’’ using the Religious Beliefs and Behaviors (RBB) scale (Connors et al. 1996). They were asked whether (Yes/No) their parents had discussed sexual topics with them (personal values about sex, delaying sexual activity, birth control, STIs, and condoms). They were also asked about the frequency of sex communication with their parents. Sex communication questions were adapted from a study by Aspy et al. (2007). Lastly, they were asked whether they intended to delay sex until marriage, rating this item on a 4-point Likert scale from ‘‘strongly agree’’ to ‘‘strongly disagree.’’ Focus Group Discussion Facilitators used a focus group discussion guide that included both open- and close-ended questions. The facilitators began the focus groups with a review of the purpose of the discussion, an assurance their comments would not be shared with parents, and a brief icebreaker. To reduce the level of possible discomfort regarding sensitive topics, youth were asked to comment on their peers’ behaviors if they were uncomfortable about discussing their own. The content of TIPS-YP intervention components will be based on the Theory of Planned Behavior (TPB; Ajzen 1991), an empirically validated behavioral change strategy commonly used in adolescent health research. TPB posits that behavioral intentions are predictive of whether a person will perform a particular behavior. These intentions are influenced by independent factors—attitudes toward the behavior, subjective norms, and perceived behavioral control. Content for the pilot study’s intervention components will be based on influencing these factors in order to enhance participants’ intention to reduce their sexual risk and engage in parent–child–church sex communication and risk reduction interventions in churches. In using the TPB model for intervention development and assessment, researchers are encouraged to conduct formative studies to elicit information on attitudes, norms, and perceived control issues related to the desired outcome behavior with the target population via qualitative methods, such as focus groups and interviews. Therefore, this study’s focus group questions inquired about beliefs regarding youth sexual activities, sources of and social support for sex communication and sexual risk reduction, and facilitators/barriers to reducing youth sexual risks and enhancing parent–child–church sex communication. Data Analysis Focus group data were analyzed on three levels: articulated, attributional, and emergent (Massey 2011). Articulated data included participants’ actual responses to questions and agreement, disagreement, or qualification on comments made by others. In order to analyze these data, the responses to specific questions were grouped together and commonalities were identified across participants’ responses. Attributional data consisted of comments that supported existing theory; responses were analyzed according to whether they support the constructs of the TPB. Finally, emergent data analysis was also used as part of a
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grounded theory approach to data analysis and included comments that provided new insights, particularly on strategies for TIPS-YP intervention developments. The first and third authors independently read the first focus group transcript and developed an initial coding scheme based on participants’ responses categorized within TPB constructs and their emergent responses regarding possible intervention strategies. They then met to compare their individual coding scheme, discuss discrepancies, and reach a consensus on a final coding scheme. This process was repeated for each transcript. Agreement between coders ranged from 83 to 94 % (agreement average = 87 %). Additionally, use of multimodal data collection strategies assisted in triangulation of the focus group discussion comments and survey data on parent–child sex communication topics to confirm the trustworthiness of qualitative discussion findings (Fossey et al. 2002, i.e., focus group and survey data both supported that youth had discussed sexual health topics with their parents and other sources). To reduce focus group facilitator reflexivity, or influence, on the quality and consistency of the collected data, experienced focus group facilitators (a) were trained on the use of the focus group discussion guide along with scripted prompts and cues to keep the discussion focused; (b) led groups in which they did not know participants; and (c) held all discussions in the same location (a church basement) without the presence of parents. All but one moderator were African American churchgoers, and all were female, which could have influenced male participants’ comfort in sharing, but similar data were obtained for male and female participants.
Results The average age of participants was 14.7 years (SD = 1.8; age range 12–19). The majority was Baptist and reported frequent engagement in religious activities. More than one-third of participants reported having had vaginal sex. Regarding parent sex communication, most youth reported that their parents had discussed delaying sex (82 %), STIs (80 %), using condoms (70 %), and using birth control (48 %), as shown in Table 1. Additionally, 54 % agreed or strongly they intended to delay sex until marriage. Focus Group Findings Themes were categorized according to the TPB constructs (attitudes, normative beliefs, perceived behavioral beliefs, intentions) and suggested intervention strategies to address parent–child–church sex communication and church-based sexual risk reduction education. Attitudes Almost all participants believed their peers were having premarital sex; however, there were differences in beliefs about whether premarital sex was a bad or good. Many participants (n = 21) held a negative attitude regarding youths’ premarital sexual behavior, sharing a belief that sex before marriage was wrong based on biblical principles and sex should wait until marriage. I think it’s wrong because it’s a sin. (‘‘Mister Sexy’’, male) You’re saving your virginity for when you get married, like, actually living your life and getting to do what you want to do and then give it as a gift or whatever to someone who loves you. (‘‘BamBam’’, female)
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J Relig Health Table 1 Sample description (N = 54) Variable
% (n)
Sex Female
59.3 (32)
Male
40.7 (22)
Denomination Baptist
74.1 (40)
Non-denominational
18.5 (10)
Church of God in Christ
3.7 (2)
Methodist
1.9 (1)
Assembly of God
1.9 (1)
Religious behaviors (reported at least weekly participation) Thought of God
81.5 (44)
Prayed
83.3 (45)
Meditated
35.2 (19)
Attended worship services
74.1 (40)
Read–studied scriptures or holy writings
59.3 (32)
Direct experiences with God
53.7 (29)
Sexual experience Had oral sex
27.8 (15)
Had vaginal sex
37.0 (20)
Had anal sex
1.9 (1)
Condom use (sexually active youth only) Always
54.2 (13)
Usually
12.5 (3)
Sometimes
12.5 (3)
Occasionally Never
8.3 (2) 12.5 (3)
Had sex while high on drugs or alcohol (sexually active youth only) Yes No
11.1 (6) 87 (47)
Parent sex communication topics discussed Personal values regarding sex
44.4 (24)
Delaying sexual activity
81.5 (44)
Birth control
48.1 (26)
STIs
79.6 (43)
Condoms
70.4 (38)
Frequency of parent–youth talks about sex in last 6 months 1–2 times
46.3 (25)
3–4 times
14.8 (8)
5–6 times
9.3 (5)
7–8 times 9 or more times
7.4 (4) 16.7 (9)
Intend not to have sex until marriage Strongly agree
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22.2 (12)
J Relig Health Table 1 continued Variable
% (n)
Agree
31.5 (17)
Disagree
27.8 (15)
Strongly disagree
16.7 (9)
For five participants, negative attitudes toward this behavior came from the belief that youth should wait until they are older and more mature. This was further enhanced by the belief that sex during high school was wrong because of consequences that could result from having sex. I think you should wait [to have sex] ‘til the latest time that you can. (‘‘Alexa’’, female) I think it’s wrong ‘cause like some people, they have kids they can’t take care of. (‘‘Cherry’’, female) There were numerous perceived negative consequences for youth engaging in sex. These comments emphasized that sex at their age could result in pregnancy, which could lead to loss of important future goals, including college and a good job. They commented that life would be difficult for a teenager who got pregnant and would also be difficult for the child of a teenager. You might have a goal, but somethin’ might come up… A baby! (‘‘Mister Sexy’’, male) You can’t go to college or fulfill your dreams like you want to. (‘‘Unique’’, female) Two female participants stated that peers were likely to gossip about other females their age that have sex. They expressed fear of peers spreading rumors or teasing them if they engaged in sex. I don’t want people going around running they mouth about me. I don’t wanna have sex with a dude and the next day everybody in the school is like, did you have sex? I don’t want that happenin’. (‘‘Shawntay’’, female) However, many other participants did not think that premarital sex was wrong (n = 16) or were indifferent or undecided on how they felt (n = 6). Two participants commented that if you educated yourself about how to be sexually responsible, then having sex during high school was acceptable, stating if ‘‘you’re well-educated and everything, it’s cool’’ (‘‘Marie,’’ female). Others commented that there are positive consequences of sex. Three participants stated sex feels good or is relaxing. Four others endorsed sex under the right circumstances, such as being in love. The right reason [to have sex] is like kids… another thing is like for marriage, if you’re in love (‘‘Unique’’, female) Many participants (n = 13) believed that their peers were not using condoms or contraception but had positive attitudes toward those who did, considering them ‘‘smart’’ (‘‘Nika,’’ female) and ‘‘responsible’’ (‘‘The Waters,’’ male). There was the perception that some peers were sexually responsible and used birth control to prevent pregnancy, which may even be encouraged by parents.
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There are some sexually active girls that are [using birth control]. They have goals and they want to live beyond just having sex in high school… or they have parents who have gone through things, single parents who want to put them on it even before they start having sex. (‘‘Briola’’, female) Two participants believed their peers were getting tested for STIs/HIV; however, the rest did not. They reported several reasons why they did not think their peers were getting tested, including fear and that youth do not want to know whether they are infected (n = 4), just not caring about the consequences (n = 2), being uniformed about STIs/HIV (n = 2), thinking they were not at risk for contracting STIs/HIV (n = 2), and parents not facilitating testing (n = 1). Normative Beliefs Friends and peers, parents, and religious sources were identified as key influences on youths’ sexual behavior. Approximately 50 % of participants stated there was peer pressure to have sex, explaining that friends pressure to have sex ‘‘because they’re going to’’ (‘‘Maughty Mah,’’ male) or because ‘‘everybody’s doing it, you gotta be doing it’’ (‘‘Staff,’’ male). They stated romantic partners could be particularly influential on youths’ decisions to have sex; ten participants believed that having an emotional connection to one’s partner could lead youth to have sex, including riskier sexual behaviors, such as not using condoms. Some boys do the quick little ‘I love you’ thing and just so the girl will do it. (‘‘LeeLee’’, female) If the girl is right for you, then you don’t use a condom. (‘‘C.J.’’, male) Five participants said their parents endorsed a message of abstinence, and many participants had received sex education from their parents. Parents were also considered key supporters of responsible sexual behavior; 52 participants mentioned their parents as supporters of them using condoms, and 12 youth stated their parents were very supportive of their getting STI testing. [My parents] are very supportive. They want you to know your status at all times. (‘‘Jack’’, male) Only two participants stated that their parents did not support condom use, and one said their parents did not support them getting STI tested, although both of these beliefs tended to be rooted in not wanting to admit to their parents that they were sexually active. Although experiences varied, most stated parent sex communication was limited, and participants had suggestions on how parents could communicate about sex: I feel that you should be allowed to make your own mistakes and the parents should correct you but they shouldn’t tell you, uh, I don’t want you to do this, I don’t want you to do that, you grounded. (‘‘Pimpin’’, male) Because they [parents] had sex early and they had consequences and so I think they, if the kids really look at that from the parent’s point of view, they might change their whole perspective on that. (‘‘LeeLee’’, female) Lastly, many participants considered religion to be influential on youths’ decisions to have sex. God (n = 6), the Bible (n = 4), pastors (n = 3), and church members (n = 13)
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were named as key religious influences. Few participants (n = 4) stated that religion and the church had no influence over their decision to have sex. Just to make sure He keeps me safe, cause like AIDS you can have it for, like, seven years and not know it, so I just pray that I never run into it. (‘‘Love’’, male) Participants were divided on whether the church supported youth using condoms (12 stated ‘‘Yes,’’ 7 stated ‘‘No’’). You tell one [church] person, like, you’re thinking about it, and they’re like ‘hey, use a condom’ and then they’ll tell [another] person and then everybody gonna be like ‘hey, use a condom.’ (‘‘Sahara’’, female) They [church members] just be like ‘no, you don’t need no condoms.’ (‘‘Brit’’, female) Several (n = 11) stated church members were supportive of youth seeking STI/HIV testing. Some participants (n = 4) felt their churches were not supportive of youth getting tested for STIs/HIV. They expressed reluctance to let church members know that they were getting tested because of concerns that they would gossip about them. Perceived Behavioral Control Beliefs Participants identified several factors that could facilitate/hamper adolescents’ efforts to reduce their sexual risks and be motivated to engage in parent–child–church sex communication. Participants stated that some biological factors played a significant role on youths’ ability to resist engaging in sexual behavior. There was a reoccurring subtheme that girls were less likely to engage in sex. Participants commented that ‘‘just being female’’ was a reason for abstaining from sex. Both male and female participants believed that female youth were more likely and able to refuse sex. I truly believe that a woman is more able to refuse [sex]. A guy’s kinda like, when you’re in that mindset, that go-get-em kind of mindset, you don’t stop until you got it. (‘‘Jack’’, male) Contrarily, others believed that lust (described as being driven by one’s hormones) was a significant determinant of whether youth had sex, influencing both males and females. Nearly half of participants reported that they could become overwhelmed by ‘‘urges’’ to have sex, stating it was hard to resist when faced with an attractive partner. Let’s say this one really, really, really, absolutely gorgeous guy or girl that you really want and you guys are just sitting there and then you’re like, you guys are just in the mood. And you know you really want to do it, so you just go at it. (‘‘Star’’, female) Participants commented that lust was particularly powerful when youth engaged in any physical intimacy, such as touching and kissing. Participants emphasized that this was more likely to happen when youth lacked maturity or self-control. [When youth] are already doing stuff like kissin’ or something and ya’ll get to that point where it’s just hard to be, like, okay, stop. (‘‘Shawntay’’, female) A few participants felt that parents could inadvertently give mixed messages that they approve of their youth having sex by providing them with condoms, which some viewed as parents giving them permission to do so. Others believed that youth were more likely to have sex if their parents had sex when they were young, stating that youth could ‘‘be
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following in their footsteps’’ (‘‘Briola,’’ female). They stated that it was especially important for parents who did have sex as teenagers to not appear hypocritical and share any negative consequences the parents experienced as a result of their decision not to delay sex. Sixteen participants strongly believed parents’ expectations positively influenced youths, especially in not wanting to disappoint their parents. Six participants believed that parents’ did not influence youths’ decisions to have sex. Many participants stated their siblings already had talked with them about sex and provided them condoms. Some (n = 4) reported that their parents had given them condoms or encouraged them to get tested. [My mother] gives me condoms. She’s not saying go out there and have sex, but she’s saying if you’re going to do it, then be protected. (‘‘Deola’’, female) Several participants stated that their churches offered STI/HIV testing opportunities: ‘‘Our church is for it [HIV testing], because we’ve got tests every year’’ (‘‘Star’’, female) Strategies for Enhanced Parent–Child–Church Sex Communication and TIPS-YP Intervention Participants shared strategies for developing the TIPS-YP intervention for enhanced parent–child–church sex communication and sexual risk reduction programs in churches. A common recommendation (n = 12) for parents communicating about sex was that conversations be ‘‘short and sweet’’ (‘‘Sahara,’’ female), as direct as possible, and to ‘‘not sugar coat it’’ (‘‘Unique,’’ female). They suggested that parents use media as part of their efforts by starting conversations during/after TV shows and movies with sexual content. Four participants mentioned the use of scare tactics in conversations about sex, with one believing that scare tactics can be useful in helping youth to delay sex and three stating scare tactics impeded effective communication and should not be used. I just want my parents to tell the truth and stop using scare tactics with me ‘cuz it’s not really workin’ so just, they like to hide stuff. They don’t like to tell me everything, so I have to find it out from other people. I just want ‘em to be more direct. (‘‘Bing’’, male) Youth believed it was essential that parents to talk on youths’ level. For some, this meant talking about sex in a manner appropriate for the youth’s age level but treating youth like an adults. I don’t want them to think of me as a friend, but I would want them to talk to me as if I was a friend. I think that would go a lot better. (‘‘Deola’’, female) They suggested that parents should begin sex conversations with questions about youth’s knowledge. One participant commented that his father begins sex conversations with ‘‘’Son, you know about sex?’ That’s what they’ll say sometimes’’ (‘‘Mailman,’’ male). Another suggested that he would like for his parents to put ‘‘a big box of condoms on [his] bed, then start talking’’ about sex (‘‘Staff’’, male). Further, parents should discuss not just abstinence but a range of topics, including sexual consequences (e.g., STIs and pregnancy) and how to prevent them and being in love before having sex. The majority reported that their parents’ sex communication already included these topics. Participants mentioned other individuals as supportive of condom use and possible substitutes for their parents in the educator role, including older siblings (n = 12), grandparents (n = 6), other relatives (n = 1), friends (n = 6), and friends’ parents.
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Participants believed the key to successful sex conversations was feelings of trust and confidentiality. I have this friend and she’s like really, really close to me as if she was my sister and her mom is like my mom, like my second mom. And so I can like, ask her for anything and I know that it’ll stay in that little triangle. So like, last time I went over there, we had a talk about it [sex] and everything and just talk about it. (‘‘Star’’, female) The church was also deemed to serve a key role in providing sex education to youth; 39 participants reporting having had sex education from their church. However, six stated church-based sex education consisted only of abstinence education and described it as ‘‘very preachy… like don’t have sex, stay abstinent, you’re going to hell’’ (‘‘Tiger Woods,’’ male). Only four participants stated the church should not be involved at all in sex education. Two specified they thought the church should focus on abstinence as the main educational topic. Waiting. That’s as far as the church needs to take it… And knowing that person before you decide to make any kind of decision. (‘‘Batman’’, male) I think the church should mainly be talking about abstinence and the prevention part should be more of your parents or, like, people you’re close to. (‘‘Star’’, female) Many participants (n = 15), however, were in favor of the church addressing STIs, teen pregnancy, and condom use and believed churches should provide comprehensive education. Prevention, condoms, how to say no, all that stuff. If they talk about it, it really does show that your community or your church cares (‘‘Keisha’’, female). Three participants stated they were not comfortable talking to all church members about sex and were concerned about being judged. One participant stated that church sex education should be implemented via ministries or youth groups and not during regular church services. In order for youth to feel comfortable, their family, particularly their parents, could not be present. Seven participants stressed that the sex education sessions needed to be confidential, and nothing discussed should be shared with parents. There was a consensus that they were comfortable with receiving sex education from church leaders, and some participants (n = 13) also agreed that their pastors would be comfortable with providing sex education, with two stating that only older pastors and deacons would not be. Two female participants stated they believed pastors would only be comfortable delivering sex education to youth of a certain age (i.e., 5th grade and up). Further, participants did not want to hear the information from older adults or older pastors, and felt that younger adults and pastors would better relate to youth, make them more comfortable, and be able to provide examples from their own lives from which youth could learn. They stated that sex educators should be trained near-peers aged 20 or younger. [They] should be old enough to know some things, but then… young enough to understand. (‘‘Amaad’’, male) They suggested church-based sex education programs could be more impactful by showing movies, passing out pamphlets, playing educational games, and holding youth group discussions. The majority of participants’ overall message was that the sex education should be delivered in an interactive, fun manner and that churches should avoid lecturing. Participants felt that a small-group setting (much like how the focus groups were held)
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would be ideal, although some said that larger groups or one-on-one conversations would also be acceptable. They recommended that sex topics be discussed in youth night lock-ins, sex education workshops, or as part of a youth concert—as long as the event was fun, entertaining, and had food. Cause at lock-in, you’re already having fun and you dedicate 30 min of the lock-in of talking about it [sex]. Just having a conversation, not like a confession or a dissertation or, like, just standing up there reading facts. It needs to be an open discussion. (‘‘Jack’’, male) Other suggestions mentioned by participants included having free on-site STI/HIV testing available during sex education events (n = 2), hearing from speakers with STIs and/or HIV (n = 3), and dividing the educational groups by age (n = 1).
Discussion This paper explored parent–child–church sex communication and sexual risk behaviors among an African American church-based youth population. Church-based youth participants in this study were highly religious: most thought about God, prayed, read scriptures, and attended church at least weekly. Yet, more than one-third reported vaginal sex experience, and the average age of participants’ first intercourse was younger than average age reported in the National Survey of Family Growth study (14.7 compared to 17 years old, respectively; CDC 2013b). Similar to general population youth, almost half of the sexually active church-based sample were inconsistent condom users (Bachanas et al. 2002), which suggests that this church-based youth sample was at risk for STIs/HIV and teen pregnancy. Reasonably, this study’s church-based youth tended to view sex in the context of religious morality. Although their sexual behaviors were similar to general population youth, many believed that engaging in sex before marriage was sinful, which is consistent with opinions regarding religion and premarital sex among African Americans (e.g., Haglund 2003; Thomas 2001). Participants also believed that going against valued, biblical principles related to premarital sex would increase the likelihood of negative consequences, pregnancy in particular, which could divert youths’ life goals and future opportunities. Youth reported that parents regularly delivered this message. Interestingly, many youth did not perceive STIs or HIV as deterrents for African American youth engaging in sex. This finding was somewhat surprising, considering the high rates of STIs/HIV in the African American youth population (CDC 2013a). Some comments by participants indicated that most of their peers were having sex but were not aware of high rates of STIs in their age group. Additionally, social pressure to have sex seemed to be salient for both males and females. Yet, participants reported gender differences regarding ability to refuse sex. Specifically, they stated that girls could easily turn down sex, but that this was much more difficult for boys to do. These perceptions could possibly reinforce beliefs among youth that females are the gatekeepers of sex and therefore not in need of sex refusal skills or males should be absolved of their responsibility to control their sexual behaviors (e.g., coercive sex with female partners, e.g., Haglund 2003). Studies with African American females indicate that many report feeling disempowered to ask their partners to use condoms and subservient to males who cannot control their sexual behaviors (Wingood and DiClemente 1998). Taken together, it suggests the continuing need for sex-specific youth
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sex communication and skill-building education including sex refusal, condom use, and balance of power in sexual relationships. Most participants commented that parents were their primary sex communicators. Yet, they reported that parents’ communication primarily focused on ‘‘just don’t do it’’ and on consequences of having sex but not on family values, morals, or positive outcomes for not having sex. This finding is consistent with findings from a study conducted by Fay and Yanoff (2000) indicating that youth wanted information about preventing such consequences and not just on abstinence. Secondarily, youth largely viewed the church as a primary source of sex communication. However, they stipulated that sex educators in church settings should be younger pastors, and adult educators need to be young enough to relate to youth. Several youth also reported communicating with God about protecting them from having sex or protecting them while having sex. This is not surprising, since 85 % reported that they prayed regularly. A study by Goggin et al. (2007) found that African American youth tended to perceive God as loving and offering support in making decisions about sexual behavior, and perceiving God as being actively involved in youths’ decision-making processes was associated with stronger intentions to delay sex and less sexual risk behavior. These findings suggest the need for further research on how aspects of the youth–God relationship can be effectively incorporated in parent–child–church sex communication and how a supportive sex education church environment can jointly protect against sexual risk behaviors. Youth provided several strategies for enhancing parent–child–church sex communication and church-based sexual risk reduction programs for consideration for future research and practice. These strategies included educating parents on how to discuss sex with their youth and helping parents understand that telling youth ‘‘not to have sex’’ is not an effective parent–child sex communication strategy. Consistent with other research (Williams et al. 2014), participants were in favor of church-based sex education programs particularly in safe settings where youth could discuss sensitive topics and have their personal information be confidential. They also stated the importance of having fun church-based youth activities (e.g., parties, hangout spots, and sports) as alternate activities to engaging in sex. Considering many African Americans, including youth, report attending church weekly (Barna Group 2007), the African American church could be an ideal setting for delivering parent–youth–church sex education and communication strategies. These are likely to be well-received given previous research has found that faith leaders overall are comfortable providing sex education to their members (Pichon et al. 2012; Smith et al. 2005). These strategies could include culturally and religiously tailored churchbased training and ongoing support sessions for parents on how to effectively communicate with their child about sex topics. Additionally, church leaders could be equipped with church-appropriate materials/activities (e.g., pastoral sermon guides, responsive readings, youth group leader discussion facilitator guides, educational skits and games, and resource cards) packaged in tool kits to efficiently communicate about sex topics and provide motivational STI/HIV prevention messages from existing church communication outlets (e.g., Sunday morning services, Sunday school, and telephone tree messaging systems). Future empirical studies examining the effects of such churchbased intervention strategies using supportive tools to assist churches in these endeavors are certainly needed.
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Limitations Although this study’s findings are from youth from multiple local churches, these findings may not be generalizable to all youth. In many instances, consensus on focus group issues was not achieved; frequently, youth were both for and against a particular issue. More research is needed to better determine the diversity of opinions (e.g., subgroups by age, sex, and denomination) among African American church-based youth in order to design the effective church-based interventions to increase parent–child–church sex communication and education programs. The differences in opinions may further suggest the need for church-based interventions that use ‘‘tool kits’’ with a variety of strategies and appeal to youth of different backgrounds. Also, since participants self-reported their survey responses, some participants knew each other personally, and a focus group format was used in church settings, it is certainly possible that socially desirable responding occurred. This could have led to participants under- and/or over-reporting by trying to appear more conservative or sexually active than they really were. However, our participants’ comments on sensitive topics discussed were consistent with their reported survey responses.
Conclusion The Black church has historically served as an agent of change in the African American community and therefore could be an ideal setting to promote enhanced parent–child– church sex communication and education. Consideration of the findings reported in this study could assist in the development of parent–child–church sex communication and education interventions that could empower the Black church to play a greater role in addressing sexual risk behaviors of African American youth.
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J Relig Health Parent, A. S., Teilmann, G., Juul, A., Skakkebaek, N., Toppari, J., & Bourguignon, J. P. (2003). The timing of normal puberty and the age limits of sexual precocity: Variations around the world, secular trends, and changes after migration. Endocrine Reviews, 24, 668–693. Pew Forum on Religion and Public Life. (2009). A religious portrait of African Americans, U.S. Religious Landscape Survey. Retrieved from http://pewforum.org/docs/?DocID=389. Pichon, L. C., Griffith, D. M., Campbell, B., Allen, J. O., Williams, T. T., & Addo, A. Y. (2012). Faith leaders’ comfort implementing an HIV prevention curriculum in a faith setting. Journal of Health Care for the Poor and Underserved, 23, 1253–1265. Regnerus, M. (2005). Talking about sex: Religion and patterns of parent–child communication about sex and contraception. Sociological Quarterly, 46, 79–105. Sherr, M. E., & Dyer, P. M. (2010). Evaluating a comprehensive abstinence-based program for minority youth: Comparing church and public school outcomes. Social Work & Christianity, 37, 28–44. Smith, J., Simmons, E., & Mayer, K. H. (2005). HIV/AIDS and the Black church: What are the barriers to prevention services. Journal of the National Medical Association, 97(12), 1682–1685. Somers, C. L., & Surmann, A. T. (2004). Adolescents’ preferences for source of sex education. Child Study Journal, 34, 47–59. Taylor, R. J., Mattis, J., & Chatters, L. M. (1999). Subjective religiosity among African Americans: A synthesis of findings from five national samples. Journal of Black Psychology, 25, 524–543. Thomas, A. J. (2001). African American women’s spiritual beliefs: a guide for treatment. Women & Therapy, 23(4), 1–12. Whitaker, D., & Miller, K. (2000). Parent–adolescent discussions about sex: Impact on peer influences of sexual behavior. Journal of Adolescent Research, 15, 251–274. Williams, T. T., Dodd, D., Campbell, B., Pichon, L. C., & Griffith, D. M. (2014). Discussing adolescent sexual health in African-American churches. Journal of Religion and Health, 53, 339–351. Wingood, G. M., & DiClemente, R. J. (1998). Gender influences and partner-related factors associated with noncondom use among young adult African American women. American Journal of Community Psychology, 26, 29–51.
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Beliefs About Sex and Parent–Child–Church Sex Communication Among Church-Based African American Youth Erin Moore • Jannette Berkley-Patton • Alexandria Bohn Starlyn Hawes • Carole Bowe-Thompson
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Springer Science+Business Media New York 2014
Abstract Parent–child sex communication has been shown to be protective against sexual risk among African American youth. The current study sought to use the theory of planned behavior as a framework for focus group discussions (N = 54 youth participants aged 12–19 years) to explore church youths’ (a) sex beliefs and values (attitudes), (b) sources and evaluation of sex communication and education (subjective norms), (c) facilitator/barriers to adolescent sexual risk reduction and communication behaviors (perceived behavioral control), and (d) intentions to engage in these behaviors. Additionally, participants identified strategies for consideration in developing tailored parent–child–church sex communication education programs for use in African American churches. Themes suggested both positive and negative attitudes toward premarital sex and parents and churches as key sources of sex education and communication. Strategies to enhance parent–child–church sex communication are discussed in the context of these findings. Keywords
Adolescents African American Church Sexual behavior Sex education
Introduction African American youth are disproportionately at risk for sexually transmitted infections (STIs) and teenage pregnancy. African American youth between 15 and 19 have the
E. Moore (&) Department of Psychology, Stetson University, 421 N. Woodland Blvd. Unit 8281, Deland, FL 32723, USA e-mail: [email protected] J. Berkley-Patton A. Bohn C. Bowe-Thompson Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64110, USA S. Hawes Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA 98195, USA
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highest rates of chlamydia and gonorrhea among all adolescents [Centers for Disease Control and Prevention (CDC), 2013a]. The chlamydia rate among Black females aged 15–19 was more than five times the rate of White females in the same age group, and the gonorrhea rate among Black females in this age group was 15 times the rate of Whites in 2012. Additionally, for Black males in the same age group, the chlamydia and gonorrhea rates were 10 times and 26 times the rates among White males, respectively. African Americans also had the second highest birth rates among adolescent females (Martin et al. 2009). Studies have shown that multiple overlapping personal and social factors contribute to African American youths’ increased sexual risk. Personal factors include reaching puberty at earlier ages than their White counterparts (Parent et al. 2003), having more sex partners than youth of other ethnicities (Ford et al. 2002), and using condoms inconsistently (Bachanas et al. 2002). African American youth are also twice as likely as White and Latino youth to report having sexual intercourse by age 13 (CDC 2004). In fact, one study found that more than half of sexually active African American girls had sex by age 14 (Bachanas et al. 2002). Also, adolescents primarily tend to report peers as a source of information on sexual health topics (Guthrie and Bates 2003). Sexually active peers are a significant social influence on adolescent sex behaviors. Moreover, peer influence is greater when adolescents report less involvement from parents (Whitaker and Miller 2000). Parent–child communication about sex has been found to be a protective factor against sexual risk among African American youth (Aspy et al. 2007; DiClemente et al. 2001; Dittus and Jaccard 2000; Hutchinson and Montgomery 2007; Jaccard and Dittus 2000). Studies have shown that African American youth whose parents engage them in discussions about sex are less likely to engage in sexual activity (DiClemente et al. 2001; Hutchinson and Montgomery 2007). Additionally, sexually active African American youth whose parents talk to them about sex were more likely to use contraception, including condoms (Aspy et al. 2007; Hutchinson and Montgomery 2007). A study with a racially diverse sample indicated that youth prefer for their parents to be a source for their sexual health information, rather than having their school and peers provide this type of information (Somers and Surmann 2004). Additionally, a study with primarily African American youth indicated that participants sought out credible sexual health information from trusted community organizations (Kimmel et al. 2013). Previous research has found that African American parents are more likely to discuss sex and birth control with their adolescent than any other racial or ethnic group (Regnerus 2005). A study by Fay and Yanoff (2000) found that youth prefer that their parents provide them with information about being sexually responsible to avoid consequences of sex, as opposed to merely ‘‘preaching’’ about abstinence. However, parents who are regular churchgoers may be more likely to focus on moral issues related to sex and less likely to discuss birth control when talking to their adolescent child compared to parents who are less frequent churchgoers (Regnerus 2005). The African American church may be an ideal forum for providing sex education with youth, education for parents on how to communicate about sex with youth, and general information about sexual health including prevention of STIs and unwanted pregnancies. For both African American youth and their parents, church is often a central part of their lives, providing them with moral guidance and a social support system (Adimora et al. 2001; Chatters et al. 1998; Giger et al. 2008; Taylor et al. 1999). Moreover, up to 80 % of African Americans report that religious beliefs are important (Pew Forum 2009), and over half of African Americans attend religious services at least two to four times a month (Barna Group 2007; Pew Forum 2009).
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Several church-based sex education programs have been developed to target African American youth, parents, and/or church leaders (Baldwin et al. 2008; Griffith et al. 2010; Marcus et al. 2004; Merz 1997; Pichon et al. 2012; Sherr and Dyer 2010); yet none have addressed increasing parent–child sex communication in addition to promoting sexual risk reduction among youth through congregational church services and relevant ministries. One church-based intervention, Taking It to the Pews (TIPS), has focused on communicating about HIV topics (including protective sexual behaviors) and promoting HIV screening in African American churches, particularly with adults (Berkley-Patton et al. 2010, 2012, 2013). Church leaders deliver the religiously and culturally tailored intervention materials and activities from a TIPS HIV Tool Kit during existing church services and ministries (e.g., young adult, women, and outreach). In the formative TIPS research phase, faith leaders participating in focus groups and TIPS meetings requested the development of a youth-oriented arm of the TIPS intervention. They determined that the aims of the TIPS youth intervention [subsequently named TIPS-Youth Promise (TIPS-YP)] should consist of (a) encouraging effective parent–child sex communication through sexual health seminars held separately and jointly with youth and parents; and (b) providing supportive TIPS-YP tools to assist church leaders in delivering religiously youth-tailored materials to promote parent–child sex communication and healthy youth sexual behaviors during church services and youth ministry meetings/events. The current study sought to understand church youths’ (a) sex beliefs and values (attitudes), (b) sources and evaluation of sex communication and education (subjective norms), and (c) facilitator/barriers to adolescent sex behaviors and communication (perceived behavioral control). Additionally, participants identified strategies for consideration in developing tailored parent–child– church sex communication and sexual risk reduction programs for use in African American churches.
Methods Sample Fifty-four African American adolescents completed surveys and participated in focus groups. Participants aged 12–19 years were recruited through church announcements made at 11 African American churches participating in the TIPS-YP project, a church-based HIV testing initiative coordinated by Calvary Community Outreach Network in the Kansas City metropolitan area. Consented participants were served a meal and compensated $5 for their participation. All aspects of this voluntary study were reviewed and approved by the university’s Institutional Review Board. Procedure Seven focus group discussions were held at an African American church. After providing parental and youth informed consent, youth completed a 10-min survey on parent–child communication and religious and sexual behaviors. The youth then participated in focus group discussions that ranged in time from 80 to 90 min. Youth selected pseudonyms to use during the focus groups to support confidentiality. Focus group discussions were led by trained facilitators and were digitally recorded and transcribed.
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Survey Measures The survey consisted of demographic questions including age, sex, sexual orientation, relationship status, church denomination, and history of sexual experience (e.g., ever oral, vaginal, or anal sex; frequency of condom use). Participants were asked how often over the past year they had thought of God, prayed, meditated, attended a worship service, read– studied scriptures/holy writings, and had direct experiences with God on a 4-point Likert scale from ‘‘rarely’’ to ‘‘daily’’ using the Religious Beliefs and Behaviors (RBB) scale (Connors et al. 1996). They were asked whether (Yes/No) their parents had discussed sexual topics with them (personal values about sex, delaying sexual activity, birth control, STIs, and condoms). They were also asked about the frequency of sex communication with their parents. Sex communication questions were adapted from a study by Aspy et al. (2007). Lastly, they were asked whether they intended to delay sex until marriage, rating this item on a 4-point Likert scale from ‘‘strongly agree’’ to ‘‘strongly disagree.’’ Focus Group Discussion Facilitators used a focus group discussion guide that included both open- and close-ended questions. The facilitators began the focus groups with a review of the purpose of the discussion, an assurance their comments would not be shared with parents, and a brief icebreaker. To reduce the level of possible discomfort regarding sensitive topics, youth were asked to comment on their peers’ behaviors if they were uncomfortable about discussing their own. The content of TIPS-YP intervention components will be based on the Theory of Planned Behavior (TPB; Ajzen 1991), an empirically validated behavioral change strategy commonly used in adolescent health research. TPB posits that behavioral intentions are predictive of whether a person will perform a particular behavior. These intentions are influenced by independent factors—attitudes toward the behavior, subjective norms, and perceived behavioral control. Content for the pilot study’s intervention components will be based on influencing these factors in order to enhance participants’ intention to reduce their sexual risk and engage in parent–child–church sex communication and risk reduction interventions in churches. In using the TPB model for intervention development and assessment, researchers are encouraged to conduct formative studies to elicit information on attitudes, norms, and perceived control issues related to the desired outcome behavior with the target population via qualitative methods, such as focus groups and interviews. Therefore, this study’s focus group questions inquired about beliefs regarding youth sexual activities, sources of and social support for sex communication and sexual risk reduction, and facilitators/barriers to reducing youth sexual risks and enhancing parent–child–church sex communication. Data Analysis Focus group data were analyzed on three levels: articulated, attributional, and emergent (Massey 2011). Articulated data included participants’ actual responses to questions and agreement, disagreement, or qualification on comments made by others. In order to analyze these data, the responses to specific questions were grouped together and commonalities were identified across participants’ responses. Attributional data consisted of comments that supported existing theory; responses were analyzed according to whether they support the constructs of the TPB. Finally, emergent data analysis was also used as part of a
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grounded theory approach to data analysis and included comments that provided new insights, particularly on strategies for TIPS-YP intervention developments. The first and third authors independently read the first focus group transcript and developed an initial coding scheme based on participants’ responses categorized within TPB constructs and their emergent responses regarding possible intervention strategies. They then met to compare their individual coding scheme, discuss discrepancies, and reach a consensus on a final coding scheme. This process was repeated for each transcript. Agreement between coders ranged from 83 to 94 % (agreement average = 87 %). Additionally, use of multimodal data collection strategies assisted in triangulation of the focus group discussion comments and survey data on parent–child sex communication topics to confirm the trustworthiness of qualitative discussion findings (Fossey et al. 2002, i.e., focus group and survey data both supported that youth had discussed sexual health topics with their parents and other sources). To reduce focus group facilitator reflexivity, or influence, on the quality and consistency of the collected data, experienced focus group facilitators (a) were trained on the use of the focus group discussion guide along with scripted prompts and cues to keep the discussion focused; (b) led groups in which they did not know participants; and (c) held all discussions in the same location (a church basement) without the presence of parents. All but one moderator were African American churchgoers, and all were female, which could have influenced male participants’ comfort in sharing, but similar data were obtained for male and female participants.
Results The average age of participants was 14.7 years (SD = 1.8; age range 12–19). The majority was Baptist and reported frequent engagement in religious activities. More than one-third of participants reported having had vaginal sex. Regarding parent sex communication, most youth reported that their parents had discussed delaying sex (82 %), STIs (80 %), using condoms (70 %), and using birth control (48 %), as shown in Table 1. Additionally, 54 % agreed or strongly they intended to delay sex until marriage. Focus Group Findings Themes were categorized according to the TPB constructs (attitudes, normative beliefs, perceived behavioral beliefs, intentions) and suggested intervention strategies to address parent–child–church sex communication and church-based sexual risk reduction education. Attitudes Almost all participants believed their peers were having premarital sex; however, there were differences in beliefs about whether premarital sex was a bad or good. Many participants (n = 21) held a negative attitude regarding youths’ premarital sexual behavior, sharing a belief that sex before marriage was wrong based on biblical principles and sex should wait until marriage. I think it’s wrong because it’s a sin. (‘‘Mister Sexy’’, male) You’re saving your virginity for when you get married, like, actually living your life and getting to do what you want to do and then give it as a gift or whatever to someone who loves you. (‘‘BamBam’’, female)
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J Relig Health Table 1 Sample description (N = 54) Variable
% (n)
Sex Female
59.3 (32)
Male
40.7 (22)
Denomination Baptist
74.1 (40)
Non-denominational
18.5 (10)
Church of God in Christ
3.7 (2)
Methodist
1.9 (1)
Assembly of God
1.9 (1)
Religious behaviors (reported at least weekly participation) Thought of God
81.5 (44)
Prayed
83.3 (45)
Meditated
35.2 (19)
Attended worship services
74.1 (40)
Read–studied scriptures or holy writings
59.3 (32)
Direct experiences with God
53.7 (29)
Sexual experience Had oral sex
27.8 (15)
Had vaginal sex
37.0 (20)
Had anal sex
1.9 (1)
Condom use (sexually active youth only) Always
54.2 (13)
Usually
12.5 (3)
Sometimes
12.5 (3)
Occasionally Never
8.3 (2) 12.5 (3)
Had sex while high on drugs or alcohol (sexually active youth only) Yes No
11.1 (6) 87 (47)
Parent sex communication topics discussed Personal values regarding sex
44.4 (24)
Delaying sexual activity
81.5 (44)
Birth control
48.1 (26)
STIs
79.6 (43)
Condoms
70.4 (38)
Frequency of parent–youth talks about sex in last 6 months 1–2 times
46.3 (25)
3–4 times
14.8 (8)
5–6 times
9.3 (5)
7–8 times 9 or more times
7.4 (4) 16.7 (9)
Intend not to have sex until marriage Strongly agree
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22.2 (12)
J Relig Health Table 1 continued Variable
% (n)
Agree
31.5 (17)
Disagree
27.8 (15)
Strongly disagree
16.7 (9)
For five participants, negative attitudes toward this behavior came from the belief that youth should wait until they are older and more mature. This was further enhanced by the belief that sex during high school was wrong because of consequences that could result from having sex. I think you should wait [to have sex] ‘til the latest time that you can. (‘‘Alexa’’, female) I think it’s wrong ‘cause like some people, they have kids they can’t take care of. (‘‘Cherry’’, female) There were numerous perceived negative consequences for youth engaging in sex. These comments emphasized that sex at their age could result in pregnancy, which could lead to loss of important future goals, including college and a good job. They commented that life would be difficult for a teenager who got pregnant and would also be difficult for the child of a teenager. You might have a goal, but somethin’ might come up… A baby! (‘‘Mister Sexy’’, male) You can’t go to college or fulfill your dreams like you want to. (‘‘Unique’’, female) Two female participants stated that peers were likely to gossip about other females their age that have sex. They expressed fear of peers spreading rumors or teasing them if they engaged in sex. I don’t want people going around running they mouth about me. I don’t wanna have sex with a dude and the next day everybody in the school is like, did you have sex? I don’t want that happenin’. (‘‘Shawntay’’, female) However, many other participants did not think that premarital sex was wrong (n = 16) or were indifferent or undecided on how they felt (n = 6). Two participants commented that if you educated yourself about how to be sexually responsible, then having sex during high school was acceptable, stating if ‘‘you’re well-educated and everything, it’s cool’’ (‘‘Marie,’’ female). Others commented that there are positive consequences of sex. Three participants stated sex feels good or is relaxing. Four others endorsed sex under the right circumstances, such as being in love. The right reason [to have sex] is like kids… another thing is like for marriage, if you’re in love (‘‘Unique’’, female) Many participants (n = 13) believed that their peers were not using condoms or contraception but had positive attitudes toward those who did, considering them ‘‘smart’’ (‘‘Nika,’’ female) and ‘‘responsible’’ (‘‘The Waters,’’ male). There was the perception that some peers were sexually responsible and used birth control to prevent pregnancy, which may even be encouraged by parents.
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There are some sexually active girls that are [using birth control]. They have goals and they want to live beyond just having sex in high school… or they have parents who have gone through things, single parents who want to put them on it even before they start having sex. (‘‘Briola’’, female) Two participants believed their peers were getting tested for STIs/HIV; however, the rest did not. They reported several reasons why they did not think their peers were getting tested, including fear and that youth do not want to know whether they are infected (n = 4), just not caring about the consequences (n = 2), being uniformed about STIs/HIV (n = 2), thinking they were not at risk for contracting STIs/HIV (n = 2), and parents not facilitating testing (n = 1). Normative Beliefs Friends and peers, parents, and religious sources were identified as key influences on youths’ sexual behavior. Approximately 50 % of participants stated there was peer pressure to have sex, explaining that friends pressure to have sex ‘‘because they’re going to’’ (‘‘Maughty Mah,’’ male) or because ‘‘everybody’s doing it, you gotta be doing it’’ (‘‘Staff,’’ male). They stated romantic partners could be particularly influential on youths’ decisions to have sex; ten participants believed that having an emotional connection to one’s partner could lead youth to have sex, including riskier sexual behaviors, such as not using condoms. Some boys do the quick little ‘I love you’ thing and just so the girl will do it. (‘‘LeeLee’’, female) If the girl is right for you, then you don’t use a condom. (‘‘C.J.’’, male) Five participants said their parents endorsed a message of abstinence, and many participants had received sex education from their parents. Parents were also considered key supporters of responsible sexual behavior; 52 participants mentioned their parents as supporters of them using condoms, and 12 youth stated their parents were very supportive of their getting STI testing. [My parents] are very supportive. They want you to know your status at all times. (‘‘Jack’’, male) Only two participants stated that their parents did not support condom use, and one said their parents did not support them getting STI tested, although both of these beliefs tended to be rooted in not wanting to admit to their parents that they were sexually active. Although experiences varied, most stated parent sex communication was limited, and participants had suggestions on how parents could communicate about sex: I feel that you should be allowed to make your own mistakes and the parents should correct you but they shouldn’t tell you, uh, I don’t want you to do this, I don’t want you to do that, you grounded. (‘‘Pimpin’’, male) Because they [parents] had sex early and they had consequences and so I think they, if the kids really look at that from the parent’s point of view, they might change their whole perspective on that. (‘‘LeeLee’’, female) Lastly, many participants considered religion to be influential on youths’ decisions to have sex. God (n = 6), the Bible (n = 4), pastors (n = 3), and church members (n = 13)
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were named as key religious influences. Few participants (n = 4) stated that religion and the church had no influence over their decision to have sex. Just to make sure He keeps me safe, cause like AIDS you can have it for, like, seven years and not know it, so I just pray that I never run into it. (‘‘Love’’, male) Participants were divided on whether the church supported youth using condoms (12 stated ‘‘Yes,’’ 7 stated ‘‘No’’). You tell one [church] person, like, you’re thinking about it, and they’re like ‘hey, use a condom’ and then they’ll tell [another] person and then everybody gonna be like ‘hey, use a condom.’ (‘‘Sahara’’, female) They [church members] just be like ‘no, you don’t need no condoms.’ (‘‘Brit’’, female) Several (n = 11) stated church members were supportive of youth seeking STI/HIV testing. Some participants (n = 4) felt their churches were not supportive of youth getting tested for STIs/HIV. They expressed reluctance to let church members know that they were getting tested because of concerns that they would gossip about them. Perceived Behavioral Control Beliefs Participants identified several factors that could facilitate/hamper adolescents’ efforts to reduce their sexual risks and be motivated to engage in parent–child–church sex communication. Participants stated that some biological factors played a significant role on youths’ ability to resist engaging in sexual behavior. There was a reoccurring subtheme that girls were less likely to engage in sex. Participants commented that ‘‘just being female’’ was a reason for abstaining from sex. Both male and female participants believed that female youth were more likely and able to refuse sex. I truly believe that a woman is more able to refuse [sex]. A guy’s kinda like, when you’re in that mindset, that go-get-em kind of mindset, you don’t stop until you got it. (‘‘Jack’’, male) Contrarily, others believed that lust (described as being driven by one’s hormones) was a significant determinant of whether youth had sex, influencing both males and females. Nearly half of participants reported that they could become overwhelmed by ‘‘urges’’ to have sex, stating it was hard to resist when faced with an attractive partner. Let’s say this one really, really, really, absolutely gorgeous guy or girl that you really want and you guys are just sitting there and then you’re like, you guys are just in the mood. And you know you really want to do it, so you just go at it. (‘‘Star’’, female) Participants commented that lust was particularly powerful when youth engaged in any physical intimacy, such as touching and kissing. Participants emphasized that this was more likely to happen when youth lacked maturity or self-control. [When youth] are already doing stuff like kissin’ or something and ya’ll get to that point where it’s just hard to be, like, okay, stop. (‘‘Shawntay’’, female) A few participants felt that parents could inadvertently give mixed messages that they approve of their youth having sex by providing them with condoms, which some viewed as parents giving them permission to do so. Others believed that youth were more likely to have sex if their parents had sex when they were young, stating that youth could ‘‘be
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following in their footsteps’’ (‘‘Briola,’’ female). They stated that it was especially important for parents who did have sex as teenagers to not appear hypocritical and share any negative consequences the parents experienced as a result of their decision not to delay sex. Sixteen participants strongly believed parents’ expectations positively influenced youths, especially in not wanting to disappoint their parents. Six participants believed that parents’ did not influence youths’ decisions to have sex. Many participants stated their siblings already had talked with them about sex and provided them condoms. Some (n = 4) reported that their parents had given them condoms or encouraged them to get tested. [My mother] gives me condoms. She’s not saying go out there and have sex, but she’s saying if you’re going to do it, then be protected. (‘‘Deola’’, female) Several participants stated that their churches offered STI/HIV testing opportunities: ‘‘Our church is for it [HIV testing], because we’ve got tests every year’’ (‘‘Star’’, female) Strategies for Enhanced Parent–Child–Church Sex Communication and TIPS-YP Intervention Participants shared strategies for developing the TIPS-YP intervention for enhanced parent–child–church sex communication and sexual risk reduction programs in churches. A common recommendation (n = 12) for parents communicating about sex was that conversations be ‘‘short and sweet’’ (‘‘Sahara,’’ female), as direct as possible, and to ‘‘not sugar coat it’’ (‘‘Unique,’’ female). They suggested that parents use media as part of their efforts by starting conversations during/after TV shows and movies with sexual content. Four participants mentioned the use of scare tactics in conversations about sex, with one believing that scare tactics can be useful in helping youth to delay sex and three stating scare tactics impeded effective communication and should not be used. I just want my parents to tell the truth and stop using scare tactics with me ‘cuz it’s not really workin’ so just, they like to hide stuff. They don’t like to tell me everything, so I have to find it out from other people. I just want ‘em to be more direct. (‘‘Bing’’, male) Youth believed it was essential that parents to talk on youths’ level. For some, this meant talking about sex in a manner appropriate for the youth’s age level but treating youth like an adults. I don’t want them to think of me as a friend, but I would want them to talk to me as if I was a friend. I think that would go a lot better. (‘‘Deola’’, female) They suggested that parents should begin sex conversations with questions about youth’s knowledge. One participant commented that his father begins sex conversations with ‘‘’Son, you know about sex?’ That’s what they’ll say sometimes’’ (‘‘Mailman,’’ male). Another suggested that he would like for his parents to put ‘‘a big box of condoms on [his] bed, then start talking’’ about sex (‘‘Staff’’, male). Further, parents should discuss not just abstinence but a range of topics, including sexual consequences (e.g., STIs and pregnancy) and how to prevent them and being in love before having sex. The majority reported that their parents’ sex communication already included these topics. Participants mentioned other individuals as supportive of condom use and possible substitutes for their parents in the educator role, including older siblings (n = 12), grandparents (n = 6), other relatives (n = 1), friends (n = 6), and friends’ parents.
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Participants believed the key to successful sex conversations was feelings of trust and confidentiality. I have this friend and she’s like really, really close to me as if she was my sister and her mom is like my mom, like my second mom. And so I can like, ask her for anything and I know that it’ll stay in that little triangle. So like, last time I went over there, we had a talk about it [sex] and everything and just talk about it. (‘‘Star’’, female) The church was also deemed to serve a key role in providing sex education to youth; 39 participants reporting having had sex education from their church. However, six stated church-based sex education consisted only of abstinence education and described it as ‘‘very preachy… like don’t have sex, stay abstinent, you’re going to hell’’ (‘‘Tiger Woods,’’ male). Only four participants stated the church should not be involved at all in sex education. Two specified they thought the church should focus on abstinence as the main educational topic. Waiting. That’s as far as the church needs to take it… And knowing that person before you decide to make any kind of decision. (‘‘Batman’’, male) I think the church should mainly be talking about abstinence and the prevention part should be more of your parents or, like, people you’re close to. (‘‘Star’’, female) Many participants (n = 15), however, were in favor of the church addressing STIs, teen pregnancy, and condom use and believed churches should provide comprehensive education. Prevention, condoms, how to say no, all that stuff. If they talk about it, it really does show that your community or your church cares (‘‘Keisha’’, female). Three participants stated they were not comfortable talking to all church members about sex and were concerned about being judged. One participant stated that church sex education should be implemented via ministries or youth groups and not during regular church services. In order for youth to feel comfortable, their family, particularly their parents, could not be present. Seven participants stressed that the sex education sessions needed to be confidential, and nothing discussed should be shared with parents. There was a consensus that they were comfortable with receiving sex education from church leaders, and some participants (n = 13) also agreed that their pastors would be comfortable with providing sex education, with two stating that only older pastors and deacons would not be. Two female participants stated they believed pastors would only be comfortable delivering sex education to youth of a certain age (i.e., 5th grade and up). Further, participants did not want to hear the information from older adults or older pastors, and felt that younger adults and pastors would better relate to youth, make them more comfortable, and be able to provide examples from their own lives from which youth could learn. They stated that sex educators should be trained near-peers aged 20 or younger. [They] should be old enough to know some things, but then… young enough to understand. (‘‘Amaad’’, male) They suggested church-based sex education programs could be more impactful by showing movies, passing out pamphlets, playing educational games, and holding youth group discussions. The majority of participants’ overall message was that the sex education should be delivered in an interactive, fun manner and that churches should avoid lecturing. Participants felt that a small-group setting (much like how the focus groups were held)
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would be ideal, although some said that larger groups or one-on-one conversations would also be acceptable. They recommended that sex topics be discussed in youth night lock-ins, sex education workshops, or as part of a youth concert—as long as the event was fun, entertaining, and had food. Cause at lock-in, you’re already having fun and you dedicate 30 min of the lock-in of talking about it [sex]. Just having a conversation, not like a confession or a dissertation or, like, just standing up there reading facts. It needs to be an open discussion. (‘‘Jack’’, male) Other suggestions mentioned by participants included having free on-site STI/HIV testing available during sex education events (n = 2), hearing from speakers with STIs and/or HIV (n = 3), and dividing the educational groups by age (n = 1).
Discussion This paper explored parent–child–church sex communication and sexual risk behaviors among an African American church-based youth population. Church-based youth participants in this study were highly religious: most thought about God, prayed, read scriptures, and attended church at least weekly. Yet, more than one-third reported vaginal sex experience, and the average age of participants’ first intercourse was younger than average age reported in the National Survey of Family Growth study (14.7 compared to 17 years old, respectively; CDC 2013b). Similar to general population youth, almost half of the sexually active church-based sample were inconsistent condom users (Bachanas et al. 2002), which suggests that this church-based youth sample was at risk for STIs/HIV and teen pregnancy. Reasonably, this study’s church-based youth tended to view sex in the context of religious morality. Although their sexual behaviors were similar to general population youth, many believed that engaging in sex before marriage was sinful, which is consistent with opinions regarding religion and premarital sex among African Americans (e.g., Haglund 2003; Thomas 2001). Participants also believed that going against valued, biblical principles related to premarital sex would increase the likelihood of negative consequences, pregnancy in particular, which could divert youths’ life goals and future opportunities. Youth reported that parents regularly delivered this message. Interestingly, many youth did not perceive STIs or HIV as deterrents for African American youth engaging in sex. This finding was somewhat surprising, considering the high rates of STIs/HIV in the African American youth population (CDC 2013a). Some comments by participants indicated that most of their peers were having sex but were not aware of high rates of STIs in their age group. Additionally, social pressure to have sex seemed to be salient for both males and females. Yet, participants reported gender differences regarding ability to refuse sex. Specifically, they stated that girls could easily turn down sex, but that this was much more difficult for boys to do. These perceptions could possibly reinforce beliefs among youth that females are the gatekeepers of sex and therefore not in need of sex refusal skills or males should be absolved of their responsibility to control their sexual behaviors (e.g., coercive sex with female partners, e.g., Haglund 2003). Studies with African American females indicate that many report feeling disempowered to ask their partners to use condoms and subservient to males who cannot control their sexual behaviors (Wingood and DiClemente 1998). Taken together, it suggests the continuing need for sex-specific youth
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sex communication and skill-building education including sex refusal, condom use, and balance of power in sexual relationships. Most participants commented that parents were their primary sex communicators. Yet, they reported that parents’ communication primarily focused on ‘‘just don’t do it’’ and on consequences of having sex but not on family values, morals, or positive outcomes for not having sex. This finding is consistent with findings from a study conducted by Fay and Yanoff (2000) indicating that youth wanted information about preventing such consequences and not just on abstinence. Secondarily, youth largely viewed the church as a primary source of sex communication. However, they stipulated that sex educators in church settings should be younger pastors, and adult educators need to be young enough to relate to youth. Several youth also reported communicating with God about protecting them from having sex or protecting them while having sex. This is not surprising, since 85 % reported that they prayed regularly. A study by Goggin et al. (2007) found that African American youth tended to perceive God as loving and offering support in making decisions about sexual behavior, and perceiving God as being actively involved in youths’ decision-making processes was associated with stronger intentions to delay sex and less sexual risk behavior. These findings suggest the need for further research on how aspects of the youth–God relationship can be effectively incorporated in parent–child–church sex communication and how a supportive sex education church environment can jointly protect against sexual risk behaviors. Youth provided several strategies for enhancing parent–child–church sex communication and church-based sexual risk reduction programs for consideration for future research and practice. These strategies included educating parents on how to discuss sex with their youth and helping parents understand that telling youth ‘‘not to have sex’’ is not an effective parent–child sex communication strategy. Consistent with other research (Williams et al. 2014), participants were in favor of church-based sex education programs particularly in safe settings where youth could discuss sensitive topics and have their personal information be confidential. They also stated the importance of having fun church-based youth activities (e.g., parties, hangout spots, and sports) as alternate activities to engaging in sex. Considering many African Americans, including youth, report attending church weekly (Barna Group 2007), the African American church could be an ideal setting for delivering parent–youth–church sex education and communication strategies. These are likely to be well-received given previous research has found that faith leaders overall are comfortable providing sex education to their members (Pichon et al. 2012; Smith et al. 2005). These strategies could include culturally and religiously tailored churchbased training and ongoing support sessions for parents on how to effectively communicate with their child about sex topics. Additionally, church leaders could be equipped with church-appropriate materials/activities (e.g., pastoral sermon guides, responsive readings, youth group leader discussion facilitator guides, educational skits and games, and resource cards) packaged in tool kits to efficiently communicate about sex topics and provide motivational STI/HIV prevention messages from existing church communication outlets (e.g., Sunday morning services, Sunday school, and telephone tree messaging systems). Future empirical studies examining the effects of such churchbased intervention strategies using supportive tools to assist churches in these endeavors are certainly needed.
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Limitations Although this study’s findings are from youth from multiple local churches, these findings may not be generalizable to all youth. In many instances, consensus on focus group issues was not achieved; frequently, youth were both for and against a particular issue. More research is needed to better determine the diversity of opinions (e.g., subgroups by age, sex, and denomination) among African American church-based youth in order to design the effective church-based interventions to increase parent–child–church sex communication and education programs. The differences in opinions may further suggest the need for church-based interventions that use ‘‘tool kits’’ with a variety of strategies and appeal to youth of different backgrounds. Also, since participants self-reported their survey responses, some participants knew each other personally, and a focus group format was used in church settings, it is certainly possible that socially desirable responding occurred. This could have led to participants under- and/or over-reporting by trying to appear more conservative or sexually active than they really were. However, our participants’ comments on sensitive topics discussed were consistent with their reported survey responses.
Conclusion The Black church has historically served as an agent of change in the African American community and therefore could be an ideal setting to promote enhanced parent–child– church sex communication and education. Consideration of the findings reported in this study could assist in the development of parent–child–church sex communication and education interventions that could empower the Black church to play a greater role in addressing sexual risk behaviors of African American youth.
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