Talking About Sex: Extended Family As Educators and Allies

Jennifer Grossman, Ph.D., is currently principal investigator of an R21 award from the National Institute of Child Health and Human Development (NICHD)—Adolescent Communication with Family and Reproductive Health, which includes the first comprehensive assessment of teens’ sexuality communication with extended family and its associations with sexual behavior as well as an exploration of extended family approaches to talking with teens about sex. Grossman is also principal investigator of an R03 award from NICHD—Risk Behaviors Among Offspring of Teen Parents: Effects of Parenting on the Next Generation, which addresses the potential of maternal and paternal parenting to reduce the high risk of early sex and teen pregnancy for offspring of teen parents. (The R21 grant mechanism is intended to encourage exploratory/developmental research by providing support for the early and conceptual stages of project development. The R03 grant mechanism supports small research projects that can be carried out in a short period of time with limited resources.)

You’re currently working on two studies that look at how family communication affects teens’ understanding of sex as well as their actual sexual behavior. How has your past work informed this?

Several years ago, I co-directed a three-year evaluation of Get Real, a comprehensive middle school sex education program developed by Planned Parenthood of Massachusetts, which delivers scientifically accurate, age-appropriate information on sexual health and relationships. Get Real includes a homework opportunity in each lesson for parents to talk with their children. And as we analyzed the data, it became clear that the communication was integral to the program’s success; I wanted to build off this finding.

Partway through our Get Real evaluation, I received funding from NICHD to begin another study looking at how teens and their families talk about sex and relationships. We explored how adolescents talk with their parents as well as extended family members— uncles, aunts, grandparents, cousins, older siblings for example—about sex and relationships. The qualitative findings from the interviews and narratives explored why teens talk with extended family about sex, and the similarities and differences in how teens talk with parents and extended family about sex and relationships. We found that teens were more likely to report that parents, rather than extended family, shared messages about delaying sex and avoiding teen pregnancy and gave advice or shared information about sex, but were more likely to describe extended family members, rather than parents, as easy to talk with and as having shared life experiences. Another finding from this project was that teens who have had sex were actually more likely to talk with extended family than those who have not had sex, which suggests the growing importance of extended family sexuality communication as teens become sexually active.

So, there could be a significant benefit for teens to talk with others in their extended families?

Yes, definitely. We know that by twelfth grade, 60 percent of teens in Massachusetts have had sex, and our own and others’ research show that talking with parents about sex can protect teens from risky sexual behavior—such as having sex at a young age or sex without a condom. However, we also know that half of teens and parents don’t talk with one another about sex and relationships. This may be due in part to teens’ concerns that their parents might judge them or worry about their sexual behaviors. Over half of teens report that they do talk with extended family members so these conversations can provide a unique opportunity for relatives to share tools that can protect teens from early sex, STIs, and pregnancy.

We believe that talking with extended family is particularly relevant for Black and Latino teens for whom extended family often has a major influence in childrearing. However, little is known about the topics of teens’ conversation with these family members, the messages and values family members share with teens, and how these conversations influence teens’ health.

What are the scopes of these newer projects?

My RO3 project is looking at the effects of parenting—by parents who were teens when they had children—on sexual risk behaviors of the next generation. We’re looking at the Add Health data (National Longitudinal Study of Adolescent to Adult Health) to investigate whether protective effects of maternal and paternal parenting on teens’ and emerging adults’ sexual health also extend to those teens from teen-parent families. We also want to know if there are any variations in parenting processes within the teen-parent families, and if so, how these may be associated with sexual behaviors. From this work, we may be able to make recommendations to health care providers on how they can better support offspring of teen parents to reduce risks for these adolescents.

With the R21 study, our research team is currently collecting data from adolescents and families in the Greater Boston area, to explore how teens communicate with their families about sex and relationships and the associations of these conversations with teens’ sexual attitudes and behaviors. Providing resources and support for teens’ health-promoting communication with family members may be especially important among diverse families where extended family members may play key childrearing roles. So we’re working with some great school partners and are surveying a diverse group of eleventh and twelfth graders in communities that have higher-than-average teen pregnancy rates and higher populations of students of color. We’re asking teens to report on the content, frequency, and quality of conversations with family members about sex and relationships. We’re asking them questions about their own sexual attitudes, beliefs, and behaviors. With this two-year study, we’re also reaching out to extended family members and hope to conduct 30 phone interviews to hear from them about their conversations with teens in their families and what resources would support health-promoting conversations with the teens.

There’s a lot to do in a short time. How are you doing it?

With a great team!

Because we’re collecting all our data online, we spent a lot of time before we gave out the survey, figuring out how to design the database so that we collect data in a way that’s seamless, and how we would code the data. For example, how do we make sure survey questions are inclusive of teens from all sorts of families? Also by using the Qualtrics online program, we can individualize surveys for each teen taking them. For example, if a teen reports she talked with her Aunt Sue about sex and relationships, we can ask her questions about what topics she talks about with Aunt Sue.

To take the survey, students can use computers at their school, cell phones, or tablets we bring to their classrooms.

Has it gone smoothly?

This project, so far, has involved both successes and set-backs. Last spring, we had collected initial letters of support from several schools, but getting approval at district levels wasn’t as easy. Schools and districts also face challenges of managing competing priorities that make it difficult to find time and resources to collaborate on a research project. Therefore we continue to recruit high schools to partner with us on this project. However, we have several great school collaborations and are currently visiting schools to talk with students and parents about our project, administering surveys, and inviting teens to ask an extended family member—their “go to” person—to be part of a family member interview sample.

What are you hoping to find out from interviewing extended family members?

At this point there’s so little research hearing from extended family members’ perspectives— except for a few studies mostly on grandmothers—that we don’t need to have a representative sample; this is just a start. What topics do extended family members talk with teens about? What are the resources they need? Does it make sense to include extended family in health education programs? And if yes, what would be the first steps to make them part of this process?

Also, not all conversations with extended family may support teens’ health. It may be that some extended family members give protective messages while others don’t. For example, some research on siblings shows that sometimes they reinforce protective messages from parents, but other times they can encourage younger siblings’ risk behavior. It only makes sense to include extended family in health education programs if there are ways to encourage teens to talk with family members who share health-promoting messages about sex and relationships.

Since many of teens’ close family relationships are not parents, it’s important to understand these connections, the messages teens hear from these family members and the impact of these messages on teens’ health. These extended family connections have unrecognized influence on teens that may have potential to support teens’ health. By addressing a gap in understanding these relationships, we hope to provide schools and curriculum developers with direction and recommendations on whether and how to include family members in health education programs.

In addition to Grossman, the research team includes Ineke Ceder, project manager; Linda Charmaraman, Ph.D.; Lisette DeSouza, Ph.D.; Lorena Estrada-Martinez, Ph.D.; Alicia Doyle Lynch, Ph.D.; Amanda Richer, M.A.; and Wellesley College student interns.

Jennifer Grossman, Ph.D., is a research scientist at the Wellesley Centers for Women whose research uses mixed methods to investigate adolescent development, sexual health, and risk-taking, with an emphasis on family communication about sex and relationships, and contexts of teens’ environment and identity, such as gender, race, and ethnicity. She has directed several grants from the National Institute of Child Health and Human Development (NICHD). She has also conducted research in collaboration with Planned Parent League of Massachusetts, including a recently completed project which assessed the initial effectiveness of a mobile website for parents of youth enrolled in PPLM’s middle school curriculum, Get Real: Comprehensive Sex Education That Works.