Title: Peer and parental relationships and their association with adolescent sexual behaviors
Description: This dissertation explores peer and parental relationship factors that influence adolescent decision-making around sexual health. An adapted conceptual model linking adolescent sexual behavior with well-being was used to guide the research throughout this dissertation. Chapter One addresses the current state of adolescent sexual health, including trends in teen pregnancy and rates of sexually transmitted infections as well as federal and state policy towards sex education. Extant research on peer and family influence on sexual health behaviors is also introduced. Chapter Two, a systematic review and meta-analysis published in The Journal of Midwifery and Women’s Health, synthesized data from nine studies measuring the association between adolescent sexting and sexual activity. Pooling data from 9,676 adolescents, the odds of reporting sexual activity was 6.3 times higher, 95% CI [4.9-8.1], Q = 14.3, I2 = 65.1, for adolescents who sent sexts compared to those who did not. Findings from this review highlight the need to include sexting in sexual health curriculum and in clinical conversations with youth about healthy relationship dynamics.

Chapter Three, a systematic review of child-reported parental monitoring instruments, followed the “COnsensus-based Standards for the selection of health status Measurement INstruments” (COSMIN) methodology, including a summative grading of evidence to examine the psychometric properties of each instrument over time. Seventy-two studies representing six monitoring instruments were evaluated. Of these, four were knowledge-based and two were solicitation or disclosure-based. Based on findings of this review, the Parental Monitoring Instrument and the Poor Family Management Subscale of the Communities that Care Youth Survey had the strongest psychometric properties and are recommended for use. Using data from 9,847 adolescents and parents who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study presented in Chapter Four examined the association between parental and perceived peer attitudes towards contraception and sex and contraceptive use at two timepoints: adolescence and emerging adulthood.

The moderating effect of perceived peer attitudes on parental attitudes and communication about birth control was also explored. Among female adolescents, adjusting for grade level, race/ethnicity, family income, adolescent attitude towards birth control, and parental communication about birth control, parental attitudes toward contraception and sex was significantly associated with contraceptive use. Of the variables studied, only family household income was significantly associated with greater contraception use at both study timepoints. Chapter Five summarizes the findings and collective themes across studies included as part of this dissertation, acknowledges study strengths and limitations, and addresses implications for advocacy, research, and policy in adolescent sexual health.