Family influences on adolescent sexual and contraceptive behavior.

A broad range of family variables affect adolescent sexual and contraceptive behavior. Family influences include: (a) the contextual and structural features of families (e.g., parent's education, marital status, sibling composition); (b) family processes, relationships, or practices of parenting (e.g., parental support, control, or supervision of teenagers); and (c) biologic or hereditary transmission of potentially important antecedents (e.g., hormones and the timing of pubertal development).

FAMILY STRUCTURAL INFLUENCES

The structure of a family provides a salient developmental context, in that children grow up usually having primary relationships with one or two biological parents, and with or without older and younger siblings. With respect to parents' marital status, many studies consistently show that living with a single parent is related to adolescents being more likely to have had sexual intercourse (see Miller, Benson, & Galbraith, 2001). Relatedly, many studies show earlier onset of intercourse, and a few studies show less contraceptive use, among teens in single parent families. Several investigators have gone beyond the bivariate relationship to show that single or divorced parents' more permissive sexual attitudes (Thornton & Camburn, 1987), lesser parental supervision, and parents' own dating activity (Whitbeck, Simons, & Kao, 1994) help explain why adolescents in some single parent families are at increased risk of pregnancy. Specifying the single parent mechanisms differently, some investigators have reported that the number of parents' relationship transitions or number of changes in parents' marital status, and time lived with single parents, are related to teens' risk of pregnancy (Capaldi, Crosby, & Stoolmiller, 1996; Miller et al., 1997; Wu & Martinson, 1993).

Having older siblings also is related to higher risk of adolescent pregnancy (see Miller et al., 2001) apparently through younger siblings' earlier onset of sexual intercourse (Rodgers & Rowe, 1988; Rodgers, Rowe, & Harris, 1992; Widmer, 1997). This effect is not due to having older siblings older per se, because the influence on younger sibs' pregnancy risk behaviors is strongest if older siblings have had sexual intercourse, and especially if older sisters have experienced an adolescent pregnancy or birth (East, 1996a, 1996b; East, Felice, & Morgan, 1993; East & Shi, 1997; Widmer, 1997).

Recent studies have found that traumatic child or adolescent experiences, especially those involving sexual abuse, are related to higher adolescent pregnancy risk (see Miller et al., 2001), both through earlier onset of voluntary sexual intercourse (Browning & Laumann, 1997; Miller, Monson, & Norton, 1995; Small & Luster, 1994) and through less consistent use of contraception (Roosa, Tein, Reinholtz, & Angelini, 1997; Stock, Bell, Boyer, & Connell, 1997).

In neighborhoods that are characterized by high residential turnover, poverty, and crime rates, and which are perceived by residents to be dangerous, adolescents tend to have early onset of sexual intercourse, low use of contraception, and high adolescent pregnancy rates (Billy, Brewster, & Grady, 1994; Brewster, 1994; Brewster, Billy, & Grady, 1993; Upchurch, Aneshensel, Sucoff, & Levy-Storms, 1999; see Miller et al., 2001). Parents or parenting adults occupy a social and economic status (SES) in the community, usually reflected by some combination of their education, occupation, and income. There is abundant evidence that parents' SES is related to adolescent pregnancy (see Miller et al., 2001); adolescents whose parents have higher education and income are more likely both to postpone sexual intercourse and to use contraception.

PARENT/CHILD RELATIONSHIPS

Many researchers have investigated the association between adolescents' sexual behavior and family process variables such as parental warmth, support, parent-child closeness, or connectedness (see Miller et al., 2001, Table 1). There is marked consistency in this body of about two dozen studies; all but a few indicate that parent-child closeness is associated with reduced adolescent pregnancy risk through teens remaining sexually abstinent, postponing intercourse, having fewer sexual partners, or using contraception more consistently. For example, parent-child connectedness or closeness is related to both daughters' and sons' postponement of sexual intercourse (Jaccard, Dittus, & Gordon, 1996; Resnick et al., 1997; Weinstein & Thornton, 1989), and to more consistent contraceptive use by sexually active teens (Jaccard et al., 1996).

Most of the evidence shows that parental supervision and monitoring of children is another important relationship dimension related to adolescents' sexual behaviors in ways that would lower their risk of pregnancy (see Miller et al., 2001). More specifically, family rules and household routines (Danziger, 1995; Ku, Sonenstein, & Pleck, 1993), parental supervision of dating activities (Hogan & Kitagawa, 1985), and parental monitoring of teens (Luster & Small, 1994, 1997; Small & Luster, 1994; Upchurch et al., 1999) all have been associated with teens not having intercourse, having a later sexual debut, or having fewer sexual partners. Parental supervision and control might also reduce teen pregnancy indirectly by decreasing childrens' association with high-risk peers, and by lowering teen alcohol and drug use, thereby decreasing teenagers' unprotected sexual intercourse.

A possible explanation for the few contrary findings in this area is that parental control is multidimensional, and it is associated with negative teen outcomes if it is excessive or coercive (Barber, 1996; Gray & Steinberg, 1999). In fact, intrusive maternal control is related to early age of first sexual intercourse (Dorius & Barber, 1998) and parents' psychological control is related to high risk behavior among sexually active daughters (Rodgers, 1999).

Parent-child communication is another dimension or process in family relationships, and its association with adolescent pregnancy risk has been investigated in more than 30 studies (see Miller et al., 2001). Results across these studies are so variable and discrepant that no simple, direct effect is discernable. There is little or no agreement between what parents and teens perceive to have been communicated between them (Newcomer & Udry, 1985), and there is no consistency in findings about whether parents' or teens' reports of their communication produces significant results. In most studies that have tested for these complexities, mothers' communication is more likely to be associated with adolescent pregnancy risk variables than father's communication, and there is a stronger effect for daughters than for sons.

Several important conceptual and methodological issues complicate our understanding of the association between parent-child communication and adolescent pregnancy risk (Jaccard, Dittus, & Litardo, in press). One is the temporal ordering of variables; there is a theoretical basis for prior parent-child sexual communication to predict more responsible adolescent sexual behavior, especially if parents disapprove of their child having sex and there is a close parent-child relationship. On the other hand, if teen sexual behaviors are known to, or suspected by parents, they might begin or intensify their communication with teens about sex and contraception. Measures of communication content--what parents and teens talk about--as well as the frequency and the quality of parent-teen communication, also vary greatly across studies. Further, associations between parent/teen communication and adolescent sexual behavior are moderated by parents' values. Recent investigations (Jaccard et al., 1996; Luster & Small, 1997; Miller, Norton, Fan, & Christopherson, 1998; Miller et al., 1999) have demonstrated that parents' sexual values, in combination with parent/child communication, have an important effect on adolescents' intercourse experience.

In a number of recent studies mediating mechanisms have been identified that could help explain how parent/child relationships (especially closeness and supervision) influence adolescents' sexual behavior. For example, in one study (Scaramella, Conger, Simons, & Whitbeck, 1998) the effects of parental warmth and involvement in 7th grade were shown to affect teen pregnancy status in 12th grade through intervening mechanisms such as deviant peer affiliations, substance use, delinquency, and academic competence. Results of other studies indicate that parent/child closeness is related to mediating mechanisms such as teens' attitudes about having intercourse; teens' depression, impulse control, academic, and prosocial activities; and teens' use of substances and association with sexually active peers; all of which are related to adolescent sexual behavior and pregnancy. In particular, several investigators (Benda & DiBlasio, 1991; Feldman & Brown, 1993; Whitbeck, Conger, & Kao, 1993; Whitbeck, Hoyt, Miller, & Kao, 1992) have suggested that a lack of closeness in the parent/teen relationship increases the negative influence of peers on adolescent sexual activity. On the positive side, parent-child closeness and involvement can reduce teen sexual behavior by enhancing their educational achievement, providing youth with opportunities to develop prosocial skills, and helping them acquire a sense of competence and worth (Ramirez-Valles, Zimmerman, & Newcomb, 1998). These mediating mechanisms are summarized in Figure 1.

FAMILY BIOLOGICAL INFLUENCES

Genetic or biological variables also can be conceptualized as family influences on adolescents' sexual behavior. For example, androgen hormone levels and the timing of pubertal development are partially hereditary, and they affect adolescent sexual behavior (Morris, 1992; Udry & Campbell, 1994). Researchers have reported positive correlations between age of menarche among mothers, daughters, and sisters (Garn, 1980; Newcomer & Udry, 1984). Further, mothers' young age of first intercourse predicts sons and daughters also having sex before age 14 (Mott, Fondell, Hu, Kowaleski-Jones, & Menaghan, 1996). Genetic, shared environmental, and nonshared environmental models show heritability for the timing of sexual intercourse among siblings, although this varies by racial and gender pairs (Rodgers, Rowe, & Buster, 1998). There also is preliminary evidence for a relationship between dopamine receptor genes and age of first sexual intercourse (Miller et al., 1999).

Androgen hormone levels (from blood serum assays) are related to adolescents' sexual arousal and noncoital sexual behaviors in cross-sectional analysis, but do not predict intercourse experience among females as consistently as among males (Udry, 1988; Udry & Billy, 1987; Udry, Billy, Morris, Groff, & Raj, 1985; Udry, Talbert, & Morris, 1986). In longitudinal data spanning 3 years, however, increases in testosterone hormones were not predictive of male adolescents' sexual behaviors: Pubertal development level was a much stronger predictor of sexual ideation and behavior (Halpern, Udry, Campbell, & Suchrindran, 1993). Both theory and research suggest that early pubertal development is a significant predictor of early transition to sexual intercourse, and earlier onset is linked with less responsible sexual practices (e.g., not using contraception and having a large number of partners).

CONCLUSIONS

Family structural and contextual characteristics influence adolescent pregnancy risk through both sexual behavior and contraceptive use. Living with a single parent, and having older sexually active siblings or pregnant/parenting teenage sisters; residing in a disorganized/dangerous neighborhood and lower SES family; and being a victim of sexual abuse all place teens at elevated risk of adolescent pregnancy. Several biological variables (timing of pubertal development, hormone levels) are related to adolescent pregnancy risk because of their association with adolescent sexual behaviors.

The most consistent finding across studies of family processes or relationships is that parent-child connectedness (parental support, closeness, warmth) is related to lower adolescent pregnancy risk, primarily through delaying and reducing adolescent sexual intercourse. Parental regulation or supervision (behavioral monitoring) of teens also is related to their lower adolescent pregnancy risk, but overly controlling or intrusive parental control appears to be related to higher risk of adolescent pregnancy. Studies of associations between parent-child communication and adolescent pregnancy risk are inconclusive, apparently because closeness of the parent-child relationship, parents' values, and communication have important interactive effects.

Relatively few investigations of adolescent pregnancy risk have been designed to test the reality that the dimensions of parent-child relationships are experienced simultaneously. Some investigators have argued persuasively that parents' attitudes and values about teen sex and pregnancy influence whether teens have sexual intercourse, the timing of their sexual debut, their number of sexual partners, their use of contraception, and whether or not they have been pregnant. Parents' values for their teen to avoid pregnancy (either through sexual abstinence or through contraceptive use) are most effectively transmitted when parents have a close relationship (connectedness) with their children. Thus, family influences that prevent teen pregnancy can be viewed as including not only parental disapproval of teen sex (or unprotected teen sex), but also having a supportive parent/teen relationship (connectedness) and appropriately monitoring (regulation) teen activities.

Onset and frequency of sexual intercourse, and the use or nonuse of contraception, are behaviors determined by a complex array of antecedents. Family variables clearly play a significant role, but they do not account for all the variance. The implication of this fact is that parents can have some influence on, but they cannot determine, whether or not adolescents have intercourse, use contraception, or become pregnant. What parents do, however, makes these outcomes more or less likely.

Figure 1. Mediated conceptual model of family relationships and
adolescent pregnancy risk.

Family             [right   Mediating          [right   Adolescent
Relationship       arrow]   Variables          arrow]   Pregnancy Risk
Variables                                               Variables

* Parent/child              * adolescents'              * had inter-
  connectedness               sexual values               course
  (closeness,                 and intentions
  warmth)                                               * early onset
                            * prosocial                   of intercourse
* Parents'                    activities
  regulation,                                           * frequency of
  behavior con-             * self restraint              intercourse
  trol (monitor-
  ing supervis-             * alcohol/drug              * number of
  ion)                        use                         sexual
                                                          partners
                            * depression
* Parents'                                              * contraceptive
  psychological             * high risk peer              use at first
  over control                associations                intercourse
  (intrusiveness)
                            * early/steady              * recent
* Parent/child                dating                      contraceptive
  communication                                           use
  (when parents
  disapprove of                                         * consistency
  adol. sex/                                              of contracep-
  unprotected                                             tive use
  sex)

Moderating Variables: Gender; Race/Ethnicity; Family Structure;
Religion/religiosity; Social/economic Status: Neighborhood Context:
Sexual Abuse

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Brent C. Miller
Utah State University

A comprehensive predecessor of this paper (titled Families Matter) was originally commissioned by The National Campaign to Prevent Teen Pregnancy (see www.teenpregnancy.org). The current condensed version was prepared as a background paper for the Surgeon General's Call to Action on Promoting Responsible Sexual Behavior, presented at an invitational conference July 16-19, 2000. For a more extensive and updated review of this literature see Miller, B. C., Benson, B., and Galbraith, K. A. (2001).

Address correspondence to Brent C. Miller, Ph.D., Utah State University, Logan, UT 84322-1450; e-mail: [e-mail].