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Parent-Child Communication about Adolescent Sex

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					Parent-Child Communication
about Adolescent Sex

W. Douglas Evans, Ph.D.
The George Washington University

OAPP Annual Grantee Conference
Alexandria, VA, December 10, 2008
Session objectives
   Describe the PSUNC evaluation and main
    findings to date
   Discuss evidence for efficacy of PSUNC in
    changing parents’ relevant knowledge,
    attitudes, beliefs, and behaviors
   Explore the use of online methodologies to
    evaluate social marketing campaigns
    Parents Speak Up National
    Campaign
   Developed by U.S. Dept. of Health and Human
    Services
   Encourages parents to talk “early and often” to their
    children about delaying sexual activity
   Target audience: parents of children ages 10-14
   Uses TV, radio, and print public service
    announcements (PSAs)
       Campaign launched June 2007, airs nationwide
   Utilizes a Website www.4Parents.gov
       Provides information to parents on how to talk with their
        children about sex
PSUNC “Muffinhead” PSA
Evaluation Using New Media
   Health marketing increasingly uses Internet
    (e.g., health information or social networking
    sites) & handheld devices (e.g., viral
    marketing)
   New media is a tool to target and tailor
    information to audiences
   Health marketing evaluation has followed suit
    with online studies
Tools for New Media Evaluation
   Online panels
       Probability based (e.g., Knowledge Networks)
       Non-probability based (e.g., Harris)
   Randomized controlled experiments (message
    testing)
   Exposing selected audiences under controlled
    conditions
Online panels
   Online panels such as Knowledge
    Networks enhance opportunities for
    message efficacy testing
   Panels allow participant multimedia
    exposure and sample selection based
    on specific target audience
   They facilitate multi-factorial designs
    (e.g., exposure x time)
Considerations for using panels
   Evaluation not done in real-world setting –
    lower external validity
   Is the campaign evaluable in real-world
    setting?
   Cost – online panels generally less expensive
   Design – online panels  rigorous designs &
    higher internal validity
   Evaluate “efficacy” of messages as opposed
    to “effectiveness” of campaign
    implementation
    Evaluation Study Overview
   Field-based effectiveness evaluation not feasible due
    to use of PSAs
        Low reach/exposure prevents measurable levels of
         awareness and detectable behavioral effects
   Efficacy study design was chosen to evaluate PSUNC
    messages under controlled conditions
        Utilized the national Knowledge Networks (KN) online panel
         to develop randomized controlled trial of parents
   Main hypothesis: Exposure to campaign will change
    knowledge, attitudes, beliefs, behaviors of parents
    about parent-youth communication
Knowledge Networks Online
Panel
   Probability-based sample of U.S. population with
    sufficient sample sizes of the target population
   Panel recruited via RDD telephone methodology
   All panelists have Internet connectivity through a
    computer or Web TV appliance provided by KN
       Enables inclusion of individuals who would otherwise not
        have Internet access
   Parents of target-age youth were randomly selected
    from the KN panel
    Randomized Controlled Trial
   All study participants first completed a baseline survey
    on knowledge, attitudes, beliefs, intentions, and
    behaviors related to parent-child communication about
    sex
   Parents randomly assigned to experiment conditions:
        Control – No exposure
        Core Treatment – Exposure to core PSUNC messages
   Treatment participants exposed to campaign spots via
    online multimedia
   Follow-up surveys conducted at 4-weeks and 6-months
    after baseline
        Mothers in core treatment condition randomized to receive
         additional messages (booster treatment) after 4-week follow-up
                   Efficacy Study Timeline
             Baseline                                     Time 1                        Time 2             Time 3             Time 4
                      Random             Four-Week                     Random           6-month           12-month           18-month
  Baseline          Assignment, 2         Follow-Up                 assignment to      Follow-Up          Follow-Up          Follow-Up
 Assessment          conditions          Assessment                   booster or      Assessment         Assessment         Assessment
                                                                       normal
 Parent-child           Condition 1—     Parent-child                 exposure        Parent-child       Parent-child       Parent-child
communication           No exposure     communication                                communication      communication      communication
                                                                   Mothers’
Parent attitudes          Mothers’      Parent attitudes           Condition 3 –     Parent attitudes   Parent attitudes   Parent attitudes
  and beliefs           Condition 2 –     and beliefs              Exposure to         and beliefs        and beliefs        and beliefs
                        Exposure to                                additional set
Parent readiness         core NAMC      Parent readiness           of NAMC           Parent readiness   Parent readiness   Parent readiness
   to change              messages         to change               messages             to change          to change          to change
                                                                   among those
 Perceptions of        Fathers’          Perceptions of            exposed at         Perceptions of     Perceptions of     Perceptions of
  child sexual       Condition 2 –        child sexual             TIME 1 (this        child sexual       child sexual       child sexual
    activity        exposure to all         activity               will be the           activity           activity           activity
                        NAMC                                       ―high‖
     Social           messages               Social                exposure               Social             Social             Social
  influences,                             influences,              condition)          influences,        influences,        influences,
demographics,                           demographics,                                demographics,      demographics,      demographics,
    parental                                parental                  Fathers’           parental           parental           parental
 involvement,                            involvement,               Condition 2 –     involvement,       involvement,       involvement,
monitoring, etc.                        monitoring, etc.           exposure to all   monitoring, etc.   monitoring, etc.   monitoring, etc.
                                                                       NAMC
Parents’ media                          Parents’ media               messages        Parents’ media     Parents’ media     Parents’ media
  influences                              influences                                   influences         influences         influences

                                         Receptivity to                               Receptivity to     Receptivity to     Receptivity to
                                          NAMC ads                                     NAMC ads           NAMC ads           NAMC ads
   Efficacy Study Sample Sizes
                               4-Week         6-Month
                 Baseline      Follow Up       Follow Up
Study          Mother Father Mother Father Mother
   Condition       s      s      s      s      s    Fathers

Control         349    340    326    321    270      280
Core
   Treatment    776    504    663    444    266      365
Booster
  Treatment     ---    ---    ---     ---   275       ---
Parent Survey
   64-item instrument, self-administered online
   Measures
       Socio-demographics
       Parental involvement
       Knowledge, attitudes, beliefs about child’s current
        or future sexual behavior
       Parent-child communication
       Media use and habits
       Reactions to PSUNC ads (treatment only)
    Statistical Analysis
   Outcome Variables
        Dichotomous indicators for whether parent response
         changed in desired direction between baseline and follow-up
         time periods
   Parents who already provided extreme desired
    response (e.g., strongly agreeing with an attitudinal
    outcome) at baseline were excluded
        i.e., only examine parents who had opportunity for change
         at baseline
   Estimate average weighted indicators for desired
    baseline to follow-up change for select attitudinal and
    behavioral outcomes, by experiment condition
   Analyzed mother and father data separately
         Parent Baseline Demographic
         Characteristics
100%

90%                                 85.8%                                                            86.6%


80%

70%

60%    57.1%


50%                                                                                      46.0%
                42.9%
                                                                              38.9%
40%

30%

20%
                                                                     13.2%
                           9.3%
10%                                             4.8%
                                                                                                              6.3%
                                                           2.0%                                                          3.4%      2.0%
 0%
       Mother   Father   Age 18-34 Age 35-55   Age 55+   Less than    High     Some     Bachelor's   White    African   Hispanic   Other
                                                           high      school   college   degree or            American
                                                          school                          higher
       Child Demographic
       Characteristics
100%
90%
80%
70%

60%                                                 52.3%
                                                            47.7%
50%
40%
30%             22.4%             24.1%    23.0%
                         19.8%
20%
       10.8%
10%
 0%
       Age 10   Age 11   Age 12   Age 13   Age 14   Male    Female
Proportion of Mothers that Indicated
Any Change Toward Desired
Outcome 4 Weeks After Baseline
70%


60%
                                                                                                54.1%*

50%


40%                                                                                   36.5%

                       29.5%***
30%


20%                                                        17.8%**
              14.8%                                                                                                             13.7%**
                                                  8.1%
10%
                                                                                                                        4.0%

0%
      Your child w ould rebel and w ant   You really don't know enough        Have you asked (recommended)         Visited the "4parents.gov"
      to engage in sexual activity even   about sexual activity or w aiting   that your child w ait to have sex?             w ebsite
       more if you talk early and often   to have sex to talk about them
                                                  w ith your child


      Significantly different from control:
      *p<0.10, **p<0.05, ***p<0.01                             Control            Core Treatment
Proportion of Fathers that Indicated
Any Change Toward Desired
Outcome 4 Weeks After Baseline
 60%


 50%


 40%                  37.0%**                                                   37.8%***


 30%                                                   27.7%**
              22.5%
                                                                        19.5%
 20%                                           16.5%
                                                                                                            13.8%***

 10%

                                                                                                     0.6%
 0%
        How sure are you that you Your child will not listen to    How much have you talked     Visited the "4parents.gov"
        can always explain to your     what you say if you talk     to your child about being             website
       child how to tell a boy/girl no     early and often              sexually active?
        if s/hedoes not want to be
               sexually active

       Significantly different from control:
       *p<0.10, **p<0.05, ***p<0.01                      Control     Core Treatment
Proportion of Mothers that Indicated
Any Change Toward Desired
Outcome 6 Months After Baseline
100%
                                                                                  89.3%*
 90%
 80%
                                                                 66.6%
 70%                                                                      62.3%
 60%
                 50.9%**                                                                                     49.7%*
                            44.6%             46.8%* 46.9%*                                          46.0%
 50%
 40%                                                                                          36.4%
          33.0%
                                       30.1%
                                                                                                                              27.0%*** 26.1%***
 30%
 20%
 10%                                                                                                                         4.5%

 0%
          How sure are you that        How sure are you that     It is not too late for you to    How much have you       Visited the "4parents.gov"
        you can always explain to you can always explain to         start talking with your    talked to your child about           website.
        your child how to make a your child ways to have child about sexual activity being sexually active?
         boy/girl wait until s/he is fun with a boy/girl without   or waiting to have sex.
           ready to be sexually        being sexually active
                   active

       Signifcantly Different from Control:                Control          Core Treatment              Booster Treatment
       * p<0.10, ** p<0.05, *** p<0.01
Proportion of Fathers that Indicated
Any Change Toward Desired
Outcome 6 Months After Baseline
 70%


 60%                                                     58.1%**
                                                                                           52.5%**
 50%

                        39.0%**                  37.5%
 40%
                                                                                  30.7%
 30%
                23.2%
                                                                                                                         19.4%***
 20%


 10%
                                                                                                                  4.2%

 0%
          How sure are you that you          You have heard that you        You are sure this is the right   Visited the "4parents.gov"
          can always explain to your       should talk early and often to    developmental time to talk                website
        child how to tell a boy/girl no if your child about waiting to      with your child about sexual
           s/he does not want to be                  have sex.               activity and waiting to have
                sexually active                                                           sex.

       Signifcantly Different from Control:                        Control              Core Treatment
       * p<0.10, ** p<0.05, *** p<0.01
 Parent Reactions to PSUNC
 General Market Television Ad
100%
            92.3%                                 92.0%
                                88.9%                                                                       88.6%
90%

80%

70%

60%
                                                                                         49.2%
50%

40%                                                                  37.0%

30%

20%

10%

 0%
            This ad is      The ad grabbed    The ad gave you Talked to friends or Talked to your         This ad said
       convincing (Agree     your attention   good reasons to   other adult family children about the      something
       or Strongly Agree)                     talk to your kids  members about             ad           important to you
                                                about sexual         this ad
                                                    activity
Logistic Regressions Showing Odds (p-
value) of Change as Function of PSUNC
Exposure (Fathers, 6-month Follow Up)
                                                       Normal
                                                       Treatment
Outcome Variable                                      Odds Ratio
Q41. Has initiated conversations with child about
                                                        1.211
  sexual activity or waiting to have sex (increased
                                                       (0.302)
  initiation)
Q42. Has talked to child about being sexually           0.998
  active (increased frequency)                         (0.989)
Q44. Has asked or recommended that child wait to        2.042
  have sex (yes)                                       (0.012)
Q29. You really don't know enough about sexual
                                                        1.645
  activity or waiting to talk about them with child
                                                       (0.070)
  (increased disagreement)
                                                        3.761
Q49a. Has visited the 4parents.gov website (yes)       (0.000)
    Summary of Findings (Mothers)
   Exposure to PSUNC related to 4-week increases in:
       Confidence teen would not rebel against parent-child
        communication
       Confidence in knowing enough about sexual activity to talk
        about waiting
       Asking child to wait to have sex
       Visits to www.4parents.gov
   Exposure to PSUNC related to 6-month increases in:
       Confidence in explaining how to wait
       Confidence explaining other ways to have fun with a boy/girl
       Belief that it is not too late to start talking to child about sex
       Frequency of talking to child about being sexuall active
       Visits to www.4parents.gov
    Summary of Findings (Fathers)
   PSUNC exposure associated with 4-week increases in:
       Self-efficacy to explain how to say “no” to sexual activity
       Confidence that child will listen to what you say
       Frequency of talking to child about being sexually active
       Visits to www.4parents.gov
   PSUNC exposure associated with 6-month increases in:
       Self-efficacy to explain how to say “no” to sexual activity
       Awareness that you should talk “early and often” to child
       Confidence this is the right developmental time to talk to child
        about sex and waiting to have sex
       Visits to www.4parents.gov
    Next Steps
   Develop multivariable models to estimate association
    between PSUNC & outcomes (paper in review)
       Control for threats to validity of experiment (e.g., prior
        exposure and/or contamination of conditions, survey
        attrition, etc.)
       Remove error from simple difference-in-difference analysis
        (e.g., control for respondent demographics, child gender,
        family characteristics and moderators)
   Conduct additional analyses of knowledge, attitudes,
    beliefs, intentions
   Follow up parents at 12 & 18 months post baseline
    (12 month data collection completed Oct 2008)
Discussion
   Doug Evans, The George Washington
    University, 202-416-0496,
    wdevans@gwu.edu

				
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