Assessment of Parent-Based Interventions for Adolescent Sexual Health A Systematic Review and Meta-analysis

IMPORTANCE Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized. OBJECTIVE To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness. DATA SOURCES A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles. STUDY SELECTION Studies were included if they: (1) sampled adolescents (mean age, <= 18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English. DATA EXTRACTION AND SYNTHESIS Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables. MAIN OUTCOMES AND MEASURES The primary outcomes were delayed sexual activity, condom use, and sexual communication. RESULTS Independent findings from 31 articles reporting on 12464 adolescents (mean age=12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d=0.32; 95% CI, 0.13-0.51; P=.001) and parent-child sexual communication (d=0.27; 95% CI, 0.19-0.35; P=.001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d=-0.06; 95% CI, -0.14 to 0.02; P=.16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose. CONCLUSIONS AND RELEVANCE Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.