Widman Laura, Evans Reina, Javidi Hannah, Choukas-Bradley Sophia
North Carolina State University, Raleigh.
University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Pediatr. 2019 Sep 1;173(9):866-877. doi: 10.1001/jamapediatrics.2019.2324.
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.
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.
A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles.
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.
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.
The primary outcomes were delayed sexual activity, condom use, and sexual communication.
Independent findings from 31 articles reporting on 12 464 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.
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.
基于父母的性健康干预措施作为能够增加青少年安全性行为的一个因素，已受到广泛关注；然而，据我们所知，尚未对基于父母的干预措施与青少年性行为之间的证据进行实证综合分析。
研究基于父母的性健康干预措施与青少年3个主要结果（延迟性活动、使用避孕套和亲子性沟通）以及几个次要结果之间的关联。我们还探讨了干预效果的潜在调节因素。
通过对截至2018年3月发表的研究进行系统检索，使用MEDLINE、PsycINFO、Communication Source和CINAHL数据库以及相关综述文章。
纳入的研究需满足以下条件：（1）样本为青少年（平均年龄≤18岁）；（2）父母参与关键干预部分；（3）采用实验/准实验设计评估项目效果；（4）包括青少年报告的行为结果；（5）样本来自美国；（6）以英文发表。
从各项研究中计算标准化均数差（d）和95%置信区间，并使用随机效应模型进行荟萃分析。二次分析评估潜在的调节变量。
主要结局为延迟性活动、使用避孕套和性沟通。
综合了31篇文章中关于12464名青少年（平均年龄 = 12.3岁）的独立研究结果。在各项研究中，基于父母的干预措施与使用避孕套情况改善（d = 0.32；95%置信区间，0.13 - 0.51；P = 0.001）以及亲子性沟通（d = 0.27；95%置信区间，0.19 - 0.35；P = 0.001）之间存在显著关联。在延迟性活动方面，基于父母的干预措施与对照项目之间未发现显著差异（d = -0.06；95%置信区间，-0.14至0.02；P = 0.16）。使用避孕套情况的关联存在异质性。调节分析显示，与年龄较大的青少年相比，针对年龄较小青少年的干预措施关联更大；与混合种族/族裔样本相比，针对黑人或西班牙裔青少年的干预措施关联更大；与仅强调父母相比，同等针对父母和青少年的干预措施关联更大；与较低剂量相比，干预项目剂量为10小时或以上的关联更大。
基于父母的性健康项目可以促进青少年更安全的性行为和认知，尽管本分析中的结果总体较为有限。调节分析指出了未来项目可额外关注以提高潜在效果的几个领域。
