In one multisite, primary health-care program in 10 large cities in the United States, 3% of participating adolescents engaged in behaviors that increased their risk for human immunodeficiency virus (HIV) infection (i.e., prostitution, injecting-drug use, male homosexual behavior, or behaviors leading to ulcerative sexually transmitted diseases (STDs)); 16% of these adolescents had had more than six sex partners or a nonulcerative STD in the previous year (1). In the United States, schools are an important setting for education about HIV and acquired immunodeficiency syndrome (AIDS); however, the potential role of parents in educating their children about this problem has not been well characterized. To determine characteristics of parents who reported discussing (or not discussing) AIDS with their 10-17-year-old children, CDC analyzed data from the 1989 National Health Interview Survey, a national multistage probability survey of U.S. households conducted by CDC's National Center for Health Statistics (2).

All significance tests and standard errors* were calculated using SESUDAAN (3). Variables that differed between parents who did and parents who did not discuss AIDS with their children were further investigated with a logit model to obtain a measure of the variables' relative importance.

*These categories represent four distinct stages of behavior change that have been applied primarily to other health behaviors and only recently to sexual behavior (6).

Of the 40,979 persons interviewed, 8058 (20%) reported being parents of children aged 10-17 years; 62% of these indicated they had discussed AIDS with their children. The proportion was greater for parents living in metropolitan statistical areas with populations of less than 100,000 persons (73.6%) than for parents in larger cities (62.7%) and did not vary by region.

Overall, mothers were more likely (74.2%) than fathers (48.9%) to have discussed AIDS with their children--a pattern that was similar in both one- and two-parent households. Non-Hispanics (63.4%) were more likely than Hispanics (51.7%) to discuss AIDS with their children; this pattern was consistent for both men and women. Of parents who indicated they knew "a lot" about AIDS, 76.3% discussed AIDS with their children, compared with 19.4% of those who indicated they knew "nothing." Based on the logit model, parental gender was most strongly associated with discussing AIDS (beta coefficient: -1.18), followed by self-assessed knowledge (beta coefficient: 0.54), knowing someone with HIV infection (beta coefficient: 0.45), and one measure of actual knowledge (i.e., knowing that a difference exists between having "the AIDS virus" and having AIDS) (beta coefficient: 0.41).

Parents who discussed AIDS with their children and those who did not were similar regarding their self-assessment for being at no risk for HIV infection (84.0% versus 86.8%), being within a defined risk group (2.0% versus 2.2%), and believing the federal government's information about AIDS (69.0% versus 69.6%) and advice on "how to help keep from getting AIDS" (84.0% versus 82.4%).

Parents who recalled having seen a television public service announcement (PSA) about AIDS in the previous month were more likely (64.1%) to have discussed AIDS with their children than were those who did not (53.4%) (p less than 0.01). The relation was similar for parents who recalled having heard a radio PSA (66.0% versus 58.2%). The greatest difference was for parents who recalled reading an AIDS-related brochure (ever: 76.2% versus never: 57.4%; in the previous month: 70.8% versus not in the previous month: 42.8%). Reported by: National AIDS Information and Education Program, Office of the Deputy Director (HIV), CDC.

Editorial Note

Editorial Note: The effects of parent-child interactions on children's health-related behaviors are complex and vary with family communication patterns and the ages and genders of both children and parents (4,5). For example, a review of school-based smoking-prevention programs suggests the involvement of parents in smoking-prevention programs before their children enter sixth grade may enhance their children's interest in the smoking-prevention programs but may decrease interest in such programs at later grades (6). Among third graders exposed to either a school-based or a home-based dietary education and modification program, those in the school-based program reported more knowledge, but those in the home-based program reported more dietary behavior change (7).

Previous studies have suggested that parent-child conversations about sexual matters have been associated with delays in initiation of sexual activity and with the increased use of contraceptives by adolescents who engaged in sexual intercourse (4,8,9). In one study, previous conversations on sexual issues strongly predicted mother-daughter communication about sexual issues (10).

Although the findings in this report indicate that mothers discuss AIDS with their preadolescent and adolescent children, the findings also underscore critical deficiencies in parent-child interactions about AIDS. For example, Hispanic parents are less likely than non-Hispanic parents to discuss AIDS with their children. In addition, parents living in small cities are more likely than those in large cities to discuss AIDS with their children, even though HIV infection is more prevalent in larger metropolitan areas. HIV education and prevention efforts targeted at children might be more effective if also directed through parents. Although peer influence may more directly affect adolescents' sexual behaviors, parents could assist in primary prevention for preadolescents and in elimination of adolescents' misperceptions about HIV transmission.

In this report, most adults indicated they used various media as sources of AIDS information. This finding underscores the need to direct some media messages toward parents and to develop brochures and other educational information for parents to use with children. For example, messages on television and radio could instruct parents about how to obtain brochures and other educational information. Potentially important strategies for preventing transmission of HIV among children include efforts to educate parents about HIV, the importance of discussing HIV with their children, and how to discuss sexual issues with children of different ages.

References

1. Stiffman AR, Earls F. Behavioral risks for human immunodeficiency virus infection in adolescent medical patients. Pediatrics 1990;85:303-10.

2. Massey JT, Moore TF, Parsons VL, et al. Design and estimation for the National Health Interview Survey, 1985-94. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989. (Vital and health statistics; series 2, no. 110).

3. Shaw BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

4. Fox GL, Colombo M, Clevenger WF, Ferguson C. Parental division of labor in adolescent sexual socialization. Journal of Contemporary Ethnography 1988;17:349-71.

5. Ritchie LD, Fitzpatrick MA. Family communication patterns: measuring intrapersonal perceptions of interpersonal relationships. Communication Research 1990;17:523-44.

6. Glynn TJ. Essential elements of school-based smoking prevention programs. J Sch Health 1989;59:181-8.

7. Perry CL, Luepker RV, Murray DM, et al. Parent involvement with children's health promotion: the Minnesota home team. Am J Public Health 1988;78:1156-60.

8. Jessor SL, Jessor R. Transition from virginity to nonvirginity among youth: a social-psychological study over time. Developmental Psychology 1975;11:473-84.

9. Furstenberg FF Jr. The social consequences of teenage parenthood. Fam Plann Perspect 1976;8:148-64.

10. Fox GL, Inazu JK. Patterns and outcomes of mother-daughter communication about sexuality. Journal of Social Issues 1980;36:7-29.

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