The relationship between maternal parenting style, female adolescent decision making, and contraceptive use.

RESEARCH The relationship between maternal parenting style, female adolescent decision making, and contraceptive use Kathleen Commendador, PhD, WHNP University of Hawaii, Hilo, Hawaii Keywords Abstract Adolescents; contraception; decision making; parenting; stress; coping. Purpose: To examine the relationship between maternal parenting style, fe- male adolescent decision making, and contraceptive behavior in multiethnic, Correspondence 14- to 17-year-old Hawaii residents. Kathleen Commendador, PhD, WHNP, Data sources: This was a descriptive cross-sectional survey design using a con- University of Hawaii, Hilo. venience sample of 112 female adolescents 14–17 years of age who came for Tel: 808-974-7764; health care from four clinics on the island of Maui and the Big Island of Hawaii. Fax: 808-974-7665; Along with a brief demographic questionnaire, maternal parenting style was E-mail: [email protected] measured by the Parental Control Scale, decision making was measured by the Flinders Adolescent Decision Making Questionnaire, and sexual activity Received: February 2010; and contraception use was measured by a non-normed Sexual History and accepted: April 2010 Contraceptive Use Questionnaire. Descriptive statistics, logistic regression, and correlations were used to analyze associations and correlations between age, doi: 10.1111/j.1745-7599.2011.00635.x maternal parenting style, decision self-esteem, decision coping (vigilant and maladaptive), and contraceptive use for sexually active female adolescents. Conclusions: No significant associations or correlations were found between age, maternal parenting style, decision self-esteem, decision coping (vigilant and maladaptive), and contraceptive use. There were significant positive cor- relations (p < .05) between maternal parenting style, age, and decision coping- complacency, suggesting that maternal parenting styles are more controlling and that decision coping-complacency increases as the adolescent ages, lead- ing the adolescents to take a less active role in decision making. The teen pregnancy rate in the United States is one States has decreased to age 17 for females and age 16 of the highest in the western world (Dangal, 2006). for males. Approximately one fourth of adolescents have An estimated 78% of these pregnancies are unintended reported they had intercourse prior to age 15 (Dangal, (Guttmacher, 2004) and result in costs of up to 9.1 bil- 2006). Despite the number of safe, effective contracep- lion dollars annually in the United States (National Cam- tive methods available, pregnancy among teenagers is still paign to Prevent Teen Pregnancy, 2006). After a 14-year prevalent. These consistent high rates of adolescent preg- decline of teen birth, a 3% increase was noted between nancies in the United States continue to generate pub- 2005 and 2006 (National Campaign to Prevent Teen Preg- lic concerns, as adolescent pregnancy has been associated nancy, 2008b). Each year in the United States, 750,000 with adverse health and social consequences. Adolescent adolescents ages 19 or younger become pregnant. Ap- mothers, particularly those under 17, are more likely to proximately 34% of the adolescent pregnancies in the have truncated education, lower paying jobs, higher lev- United States result in abortion while 57% result in live els of unemployment, larger families with close spacing of births (Guttmacher, 2006). children and a higher likelihood of marital disruption, fu- ture out-of-wedlock pregnancies, low birthweight babies, In the United States, 45.9% of females and 48.8% of and poverty status (Aquilino & Bragadottir, 2000). Al- male adolescents between ages 15 and 19 have had inter- though access to initiating contraception for adolescents course (National Campaign to Prevent Teen Pregnancy, has increased, adolescents are erratic contraceptors, as 2008a). The average age of first intercourse in the United Journal of the American Academy of Nurse Practitioners 23 (2011) 561–572 C 2011 The Author(s) 561 Journal compilation C 2011 American Academy of Nurse Practitioners

Maternal parenting style K. Commendador they do not use contraception consistently (Woods et al., hold multiple viewpoints and compare them. Older ado- 2006). lescents are more likely to be aware of risks and more likely to consider future consequences. They are able to With nearly 750,000 teenage pregnancies occurring seek out, weigh the advice of individuals, and use this each year in the United States, an understanding of ado- information to make independent decisions. lescents’ decision making in contraceptive use is one of the first steps toward creating solutions for this problem. Multifactor influences on adolescent sexual The policy toward abstinence in the United States has not activity, decision making, and contraception worked. Kirby (2008) reviewed 56 studies that assessed the impact of abstinence in their curricula on adolescents’ Over the past 20 years, the literature reveals a wide ar- behavior revealing that most abstinence programs did ray of factors that may influence adolescent sexual ac- not delay initiation of sex, nor have any significant posi- tivity and contraceptive decision-making behavior. Al- tive effects on any sexual behavior. While there is over- though dated, one of the first studies by Brooks-Gunn whelming evidence provided by Kirby that abstinence and Furstenberg (1989) suggested that biological, family, programs do not work, Jemmott, Jemmott, and Fong peer, school, and community factors influence age of ini- (1998) reported that their research study curriculum, tiation of sexual intercourse. Further research in the area Making a Difference, delayed sexual experience among vir- by Brooks-Gunn and Paikoff (1991) proposed that cul- gins. Santelli et al. (2006) stated that although abstinence tural factors, sexual desire, media, biological factors, emo- for sexual intercourse is a healthy choice for adolescents, tional factors, social cognitive factors, and environmental “abstinence only” as a single option is flawed. Evaluations factors (peers and parents) influence sexual well-being of programs did not provide evidence that they delayed and sexual behavior. Recently, Browning, Burrington, initiation of sexual intercourse. While there are pros and Leventhal, and Brooks-Gunn’s (2008) research measured cons from various research studies on the subject of ab- levels of concentrated poverty, residential instability, and stinence, many adolescents are sexually active and con- aspects of immigrant concentration and the prevalence of traception remains a significant part of the national effort early adolescent multiple partnering, revealing that there to reduce adolescent pregnancy. is evidence that neighborhood affects adolescent high- risk sexual activity. Numerous researchers rate a wide Decision making variety of influences such as school underachievement, poverty, racism and discrimination, the media, and family Understanding how adolescents make decisions about structure as contributing factors to early adolescent sex- sexual activity and the use of contraception poses a chal- ual behavior (Berry, 2000; Brown, 2000; Doswell et al., lenge. Several views suggest that adolescents make de- 2003). The type of neighborhood environment may also cisions differently than adults. Gage (1998) stated that influence the likelihood of adolescent sexual initiation the physiological changes occurring in adolescence con- (Roche et al., 2005). Commendador (2003) concluded tribute to increased sexual motivation. Gage also pro- that decision making and contraception were influenced posed that as children go through adolescence they are by the integration of intimacy and closeness of the re- susceptible to peer pressure. Perceptions about what lationship; family, partner, and peer influences; locus of peers are doing and thinking and what is accepted are control; and self-image. A later study by Commendador strong motivators related to engaging in sexual activity. (2007) revealed that self-esteem did not influence ado- These seem to outweigh their perceptions about the opin- lescent contraceptive behavior. ions of parents and of other family members. Weinberger, Elvevag, and Giedd (2005) proposed that less than ma- Maternal influence on sexual activity and ture frontal lobes of the brains of adolescents contribute contraceptive decision making to poor decision making in relation to estimating frequen- cies and probabilities. Steinberg (2005) proposed that Over the years, researchers have examined mater- adolescents’ evaluate possible consequences from their nal influences in the area of adolescent sexual activity actions differently than adults do, resulting in more risky and contraceptive decision making. Associations were re- decisions with adverse outcomes. vealed between maternal/adolescent communication re- garding sexual activity and the intentions to abstain or One of the main ways that adolescents become more less likelihood of initiation of sexual intercourse (Doswell autonomous is in the growth of their decision-making et al., 2003; Fasula & Miller, 2006; McNeely et al., capabilities. Decision-making capabilities improve as the 2002; Romo, Lefkowitz, Sigman, & Au, 2002). Miller, adolescent ages and develops more competence in de- Kotchick, Dorsey, Forehand, and Ham (1998) determined cision making, becoming more autonomous. This more sophisticated reasoning process allows the adolescent to 562

K. Commendador Maternal parenting style that mothers of black and Hispanic adolescents were the 2007; Miller, 2002). In another study, the results showed primary parental communicators in the family about sex- that less parental monitoring predicted early sexual ac- ual topics. McKee, Karasz, and Weber’s (2004) research tivity, less condom use, and for females more sexual showed that before the onset of sexual activity, most girls partners (Wight, Williamson, and Henderson (2006). In rely heavily on mothers for healthcare advice. Mothers contrast, Borawski, Ievers-Landis, Lovegreen, and Trapi communicating disapproval about sexual activity and the (2003) study showed that with lower parental monitor- quality of their relationship with their daughters influ- ing there was an increase in sexual activity, alcohol, and enced later initiation of sexual activity (McNeely et al., marijuana use but more consistent condom use. Hueb- 2002). Adolescents’ perceptions of maternal disapproval ner and Howell (2003) found no effect for parenting style of premarital sex and maternal connectedness were di- on level of sexual risk taking. DiClemente et al.’s (2001) rectly related to delays in first sexual intercourse (Sieving, study showed that lower parental monitoring resulted McNeely, and Blum, 2000). Dittus and Jaccard’s (2000) in noncontraceptive use. Adolescents rated their parents research revealed that maternal disapproval of premar- as having the highest influence on sexual opinions, be- ital sex and satisfaction with mother–child relationships liefs, and attitudes (Simanski, 1998). According to Lagana were significantly related to abstinence from sexual ac- (1999), an informative family and peer environment was tivity, less frequent sexual intercourse, fewer adolescent supportive of responsible sex choices and conducive to pregnancies, and more consistent use of contraceptives. contraception. Bonell et al. (2006) studied children of Interestingly, maternal approval was also correlated with lone parent families or teen mothers and found that the increased incidence of sexual activity. Open communi- children were more likely to report early sexual debut cation between mothers/adolescents increased condom and contraception but this was not generally explained use (Miller, 2002; Miller & Whitaker, 2001; Romer et al., by parenting style. 1999; Romo et al., 2002), and adolescents were less likely to have initiated sexual intercourse (Dilorio, Kelley, & Purpose Hockenberry-Eaton, 1999). There are a multitude of factors influencing adolescent Parenting style and sexual activity and sexual debut and contraceptive decision making that lend contraceptive decision making themselves to research; however, the purpose of this re- search project was to explore the relationship between Parental behavior control, as defined by parents’ efforts maternal parenting style and adolescent decision making to set firm rules and monitor children’s activities within and contraceptive use. and outside the home, has been found to play an impor- tant role in protecting adolescents from involvement in Conceptual framework sexual risk behaviors, including early sexual intercourse (Roche et al., 2005). The theory used to guide this study was Janis and Mann’s (1977) conflict theory of decision making that Adolescents referred to parents with authoritative (de- involves using a stress and coping framework. This same manding, responsive, and monitoring) parenting style framework has been thoroughly described in the author’s for more moral decisions. In contrast, adolescents with previous research on the relationship between female parents that had authoritarian (demanding but not adolescent self-esteem, decision making, and contracep- responsive, expect rules to be obeyed without explana- tive use (Commendador, 2007). In brief, the decision- tion) parenting styles referred to their peers for moral and making process involves choice, commitment, and con- informational decisions (Bednar & Fisher, 2003) and had flict as well as the potential for loss and the decision more chronic indecision tendencies (Ferrari & Olivette, maker goes through stages of choosing the best course 1993). Adolescents with controlling parents showed an of action. When the choice is made, the decision maker increase in adjustment (depressive tendencies and antiso- may experience decisional conflicts about the final course cial behavior) problems (Conger, Conger, & Scaramella, of actions related to possible consequences of loss. Antici- 1997) and having overcontrolling parents was related to patory regret about these potential losses leads to degrees a higher risk of pregnancy (Miller, 2002). Romer et al. of decisional conflict and stress (Chambers & Rew, 2003). (1999) reported higher parental monitoring was corre- lated with less initiation of sex preadolescence and lower This decision-making theory (Janis & Mann, 1977) rates of sexual initiation as children aged and increased revealed four basic patterns of coping with the stress of adolescent contraception (Kirby, 2001). Parental con- decision making derived from making difficult or conflic- nectedness, closeness, supervision, and behavioral moni- tive decisions. These patterns of coping are further cate- toring decreased the risk of adolescent pregnancy (Kirby, gorized into two groups: adaptive and maladaptive. The 563

Maternal parenting style K. Commendador adaptive category, called the vigilant decision maker, is tions and prescriptions” (p. 360). Parental control deals the highest level of decision making and requires the with styles of discipline, not actual methods or techniques performance of a thorough information search and the parents use to enforce compliance. ability to assimilate new information. In the maladap- tive category, the nonvigilant decision maker is viewed Methods as an incompetent decision maker, who makes poor de- cisions when faced with a vital choice that has serious The methodology used in this research study was very consequences. The maladaptive category includes three similar to the methodology used in Commendador’s coping patterns: complacency, cop-out, and panic. Com- (2007) study on adolescents’ self-esteem, decision mak- placency occurs when the decision maker ignores infor- ing, and contraceptive behavior. mation about risk and losses and decides to continue the present course of action or choose whichever new course Research questions of action is suggested. Cop-out occurs when the decision maker escapes conflict by procrastinating or shifting the The three research questions in this study were: responsibility to someone else. Panic occurs when the de- cision maker panics and frantically searches for a way out 1. What is the level of maternal control (permissive of dilemmas and then impulsively chooses a solution. vs. strict), decisional self-esteem, decision-coping patterns, and contraceptive behavior? Conflict theory also predicts that people who have a specific sense of self-esteem and self-confidence in their 2. What is the relationship between age, maternal decision-making ability, or decisional self-esteem, are as- control (permissive vs. strict), decision self-esteem, sociated with a positive general self-concept and are more decision-coping patterns, and adolescent contra- likely to engage in vigilant decision making. Conversely, ceptive behavior? those who have low self-esteem and low self-confidence experience more stress and are likely to practice hyper- 3. Is there a significant association between age, ma- vigilant, panicky, defensive avoidance (evasiveness-cop- ternal control (permissive vs. strict), decision self- out), or complacent decision making (Mann, Harmoni, & esteem, decision-coping patterns, and adolescent Power, 1989). contraceptive behavior? Parental control The participants in this cross-sectional study were recruited from four clinics from different geographic How parents oversee and regulate the behavior and ac- locations from the Big Island of Hawaii and Maui, which tivities of adolescents has been a topic of considerable resulted in a more diverse population. This convenience interest to socialization researchers for years. Parental sample included 14- to 17-year-old females who came behavior control, as defined by parents’ efforts to set into the clinic for health care. Exclusion criteria in- firm rules and monitor children’s activities within and cluded those who did not speak English and those who outside the home, has been found to play an impor- were seeking prenatal care. Demographic data collected tant role in protecting adolescents from involvement in consisted of age, grade, ethnicity, ethnic identification, sexual risk behaviors, including early sexual intercourse adolescent’s living situation, and maternal and paternal (Roche et al., 2005). Parental control has been used to education. describe parenting styles and includes parental behav- ior control and parental psychological control. Of inter- Instruments est in this study is parental behavioral control. Rohner and Khaleque (2005) described parental control on a con- Along with the demographic questionnaire, three in- tinuum. On one end of the continuum is permissiveness struments were used to measure study variables: (a) Par- control and on the other end is restrictive control. Be- ent Control Scale: Mother (PCS; Rohner & Khaleque tween these extremes is flexible control (moderate and 2005), (b) Flinders Adolescent Decision Making Ques- firm control combined). Rohner and Khaleque (2005) tionnaire (FADMQ; Mann, Harmoni, Power, Beswick, & stated “behavior control has two components: (a) the ex- Ormond, 1988), and (c) a Sexual History and Contracep- tent to which parents place limits or restriction on their tive Use Questionnaire developed for this study. children’s behavior (i.e., the extent to which parents use directives requiring compliance, make demands, and es- Parental control tablish family or household rules) and (b) the extent to which parents insist on compliance with these proscrip- The PCS was created by Rohner and Khaleque (2005) from three control scales on Schaefer’s “Children’s Report of Parental Behavior Inventory” (Schaefer, 1965). It is a 13-item self-report instrument, which assesses individu- als’ perceptions of behavioral control (permissiveness or 564

K. Commendador Maternal parenting style strictness). Responses are on 4-point Likert scale from al- activity. The response format for the question how often most always true, sometimes true, rarely true, and almost contraception was used in the present ranged from (a) never true. Permissiveness is defined as conditions where none of the time, (b) a few times, (c) half of the time, (d) parents use only minimum control over their child’s most of the time, and (e) all of the time. behavior. Strictness or restrictive controls are the many conditions or rules and enforcement of the rules that par- Procedure ents impose on the child in various situations and condi- tions (Rohner & Khaleque, 2005). The scores on the PCS Once the proposal was approved by the University Of range from a low of 13 (minimum behavioral control or Hawaii’s Committee on Human Subjects for waived par- maximum permissiveness) to a high of 52 (maximum re- ent consent, a collaborative meeting with the sites was striction). Scores between 13 and 26 indicate low control; conducted to discuss recruitment of study participants. 27–39 moderate control; 40–45 firm control, and 46–52 Female adolescents who came into the clinic were ap- strict control. Internal reliability (Cronbach’s alpha de- proached by the clinic staff to determine if they were in- rived from a meta-analysis of 26 studies was 0.73. The terested in participating in the study, if they were, they PCS has been validated for use on both male and female were given packets containing an initiation and informa- children, adolescents, and adults cross-culturally world- tion about the study, the survey, a list of high school wide as well as cross-culturally in the United States. The counselors, teen resource card, and consent to partici- Child PCS: Mother Version was used for this study. pate. As an incentive, once the survey was completed, the participant was given two movie tickets to use at Decision self-esteem and decision-coping patterns her leisure. Surveys were collected from June 2009 to September 2009. In keeping with health information pri- The FADMQ (Mann et al., 1988) is a 30-item self- vacy requirements, no patient identification was included report instrument measuring competent and maladaptive on data sheets in this study. decision-making style. The response format ranges from almost always true, often true, sometimes true, and not at Data analysis all true for me. There are three subscales: (a) the decision self-esteem scale measuring the respondent’s confidence Data analysis was carried out using SPSS 17 (“SPSS,” in making decisions; (b) the vigilance scale assessing the 2008) and consisted of descriptive statistics, a correla- reported use of considering goals, generating options, tion matrix, and logistic regression. Analysis of date de- gathering facts, evaluating the consequences, reviewing mographics was carried out using descriptive statistics, the decision process, and implementing the decision; and frequency distributions, and percentages on the ordinal (c) the maladaptive subscale measuring panic, cop-out, data. and complacency. On the vigilant decision-making and self-esteem scales, high scores represent competent deci- Power analysis sion making and confidence. A high score on the mal- adaptive scale indicates poor decision making (Mann et A power analysis was performed based on correlation al., 1988; Ormond, Luszcz, Mann, & Beswick, 1991). This and logistic regression analysis with five predictor vari- instrument has been used in several studies (Friedman ables. A power of 0.80 was conducted to determine a & Mann, 1993; Johnson, 1994; Ormond, Luszcz, Mann, sample size. A power analysis at the power of 0.80 for & Beswisk, 1991) and demonstrated adequate Cron- Pearson’s Moment Correlation generated a sample for bach’s reliabilities ranging from .6 to .84. A similar study medium effect size of 0.3 (two-tailed alpha = .05) as (Commendador, 2007) on female adolescent self-esteem, N = 82. The power analysis at the power of 0.80 for logis- decision making, and contraceptive behavior showed ad- tic regression analysis for five predictors was 100. There- equate reliability with this instrument with Cronbach’s fore, the actual sample size of 112 was adequate to estab- alpha’s of: decision self-esteem and decision vigilance, .7, lish power. decision panic, .7, decision cop out, .6, decision compla- cency .642, and decision maladaptive, .827. Results Sexual History and Contraceptive Use Description of sample Questionnaire A convenience sample of 112 ethnically diverse fe- Using a response format of yes or no, the sexual his- male adolescents participated in the study. The survey tory questionnaire asked about current and past sexual was distributed to four clinics. Respondents ranged in age form 14 to 17 years with a mean of 15.8 (see Table 1). 565

Maternal parenting style K. Commendador Table 1 Number and percentage of respondent’s by age and clinic site Decisional self-esteem and decisional-coping vigilance Age (years) Frequency Percent The highest total possible score on each of these 14 15 13.4 subscales was 18. Higher scores represent higher de- 15 20 17.9 cisional self-esteem and vigilance. Vigilance represents 16 42 37.5 using goals, generating options, gathering facts, and 17 35 31.3 evaluating the consequences and is considered adap- Kona Planned Parenthood 48 42.9 tive decision making. A higher score represents compe- Maui Planned Parenthood 50 44.6 tent decision making. The item total mean for decision Hamakua Health Center 10 8.9 self-esteem was 11.87 and for decision-coping vigilance Waimea Women’s Center 4 3.6 10.62. Cronbach’s alpha reliability statistic for both scales was .7, indicating reliable internal consistency. The respondents were asked two questions regarding Decision-coping maladaptive ethnicity. The first indicated self-identified ethnicity and allowed participants to indicate more than one ethnic- The maladaptive scale was formulated by combin- ity. Respondents’ ethnicities were coded and categorized ing items related to panic, cop-out, and complacency. in the following groups: Hawaiian/part Hawaiian/Pacific There were 18 items in this subscale with a total pos- Islander (48%) followed by Asian/Part Asian (28.6%), sible score of 54. The total item mean was 17.31. High Caucasian (20.5%), Hispanic (5.4%), and African Amer- scores represented maladaptive decision making. Cron- ican (3.6%). The second question indicated what ethnic- bach’s alpha reliability statistic was .8, indicating internal ity they identified with. Ethnic identification attempted to consistency. differentiate which ethnic group the respondent believed best represented her identity. The identities the respon- Sexual history and contraceptive use questionnaire dents identified most with were Caucasian (32.1%) and Asian (31.3%). The rest of the population demonstrated The two questions in the survey addressing sexual ac- ethnic identification diversity with 13.4% part Hawai- tivity were whether the participant ever had sex and was ian, 23.5% Hawaiian, Hispanic (5.4%), Pacific Islanders she currently sexually active. Notably, 90.2% reported (4.5%), and African American (0.9%). that they were currently sexually active at the time the study was administered while there were 8.9% report- The typical respondent lived with both parents ing they had never had intercourse. The combination of (53.6%); majority of parents were high school graduates. current sexual activity and contraception was analyzed. The living situations were diverse; the largest group of The responses ranged from 45.1% sexually active and not participants, 36.7%, lived with both parents followed by using contraception to 54.9% sexually active and using 17.9% living with mom/female guardian. contraception. Research question 1 In order to answer the following two research ques- tions, the subsample of those adolescents who were cur- 1. What is the level of maternal control (permissive rently sexually active (n = 101) was used in the anal- vs. strict), decisional self-esteem, decision-coping ysis. Contraceptive behavior was defined as adolescents patterns, and contraceptive behavior? who were using contraception all the time and those who were sexually active and not using contraception all the time. Parental control Research question 2 The scores on the PCS ranged from a low of 13 (mini- What is the relationship between age, maternal con- mum behavioral control or maximum permissiveness) to trol (permissive vs. strict), decision self-esteem, decision- a high of 52 (maximum restriction). Scores between 13 coping patterns, and adolescent contraceptive behavior? and 26 indicate low control; 27 and 39 moderate control; 40 and 45 firm control; and 46 and 52 strict control. The The Pearson’s product-moment correlation point- Cronbach’s alpha reliability statistic for the PCS was .83, biserial statistical test was used to analyze correlations indicating acceptable reliability. The scores of the partici- between the variables. In order to run this analysis ado- pants ranged from 12 to 45, with a mean of 28.33 depict- lescent contraceptive behavior includes only those who ing moderate control. There were no unanswered items. were sexually active at the time of the survey was ad- ministered (n = 101; see Table 2). 566

Table 2 Correlation matrix of participants’ age, parental control scale, decision coping (vigilant and maladaptive), and sexual activity and contraceptive use. K. Commendador Flinders Flinders Flinders Flinders Flinders Sexually active, decision using/not coping coping coping coping self-esteem using subscale Participant’s PCS Maladaptive complacency cop-out panic vigilance contraception –.033 age total subscale subscale subscale subscale subscale .732 .044 112 .660 Participant’s age Pearson correlation 1 .237∗ .051 .050 –.009 .089 .092 –.071 101 Sig. (two-tailed) .012 .596 .600 .927 .349 .337 .456 .113 PCS total N 112 112 112 112 112 112 112 112 .259 Pearson correlation .237∗ .115 .235∗ .062 –.004 –.026 –.475∗∗ 101 Maladaptive subscale Sig. (two-tailed) .012 1 .227 .013 .516 .964 .782 .000 –.124 N 112 112 112 112 112 112 112 .218 Flinders coping complacency Pearson correlation .051 112 .879∗∗ .910∗∗ .824∗∗ –.002 –.495∗∗ 101 subscale Sig. (two-tailed) .596 .115 1 .000 .000 .000 .986 .000 –.095 N 112 .227 112 112 112 112 112 .344 Flinders coping cop-out Pearson correlation .050 112 112 .756∗∗ .529∗∗ –.165 –.430∗∗ 101 subscale Sig. (two-tailed) .600 .235∗ .879∗∗ 1 .000 .000 .082 .000 –.091 N 112 .013 .000 112 112 112 112 .367 Flinders coping panic subscale Pearson correlation –.009 112 112 .630∗∗ .041 –.313∗∗ 101 Sig. (two-tailed) .927 .062 112 .756∗∗ 1 .000 .666 .001 –.135 Flinders coping vigilance N 112 .516 .910∗∗ .000 112 112 112 .178 subscale Pearson correlation .089 112 .000 112 .130 .410∗∗ 101 Sig. (two-tailed) .349 –.004 112 .630∗∗ 1 .173 .000 .080 Flinders decision self-esteem N 112 .964 112 .529∗∗ .000 112 112 .424 subscale Pearson Correlation .092 112 .824∗∗ .000 112 101 Sig. (two-tailed) .337 -.026 .000 112 .130 1 1 .012 Sexually active, using/not N 112 .782 112 .041 .173 .907 using contraception Pearson correlation –.033 112 112 -.165 .666 112 112 112 101 Sig. (two-tailed) .732 –.071 -.002 .082 112 –.313∗∗ .410∗∗ .012 N 112 .456 .986 112 –.430∗∗ .001 .000 .907 1 Maternal parenting style Pearson correlation .044 112 112 –.495∗∗ .000 112 101 Sig. (two-tailed) .660 .113 –.475∗∗ .000 112 –.135 112 101 N 101 .259 .000 112 –.091 .178 .080 101 112 –.095 .367 101 .424 –.124 .344 101 101 .218 101 101 ∗p = .05.∗∗p = .01. 567

Maternal parenting style K. Commendador Table 3 Results of logistic regression and independent variables—age, maternal control, decision self-esteem, decision-coping vigilance, decision-coping maladaptive and dependent variable sexually active, and contraceptive use 95% confidence interval for Exp. (B) Variable B SE Wald df Sig. Exp. (B) Lower Upper Age 0.092 0.207 0.198 1 .657 1.096 0.731 1.644 1.033 0.976 1.093 Parent control 0.033 0.029 1.284 1 .257 1.008 0.879 1.157 1.051 0.932 1.183 Decision self-esteem 0.008 0.070 0.014 1 .906 0.970 0.924 1.019 Decision-coping vigilance 0.049 0.061 0.649 1 .420 Decision-coping maladaptive –0.031 0.025 1.499 1 .221 There were positive correlations (p = .05) between PCS, ian ancestry, although only 12.5% identified with be- age (r = .237), and Flinders decisional coping compla- ing Hawaiian. Ethnic identification of the population in cency (r = .235) and negative correlations (p = .01) be- Hawaii is a subject of ongoing research. tween Flinders coping maladaptive scale (r = –.475) and the Flinders decision self-esteem (r = –.475). Ninety-two percent of the subjects (n = 112) were sex- ually active at the time of the study. There were 8.9% Research question 3 who had never had intercourse. The participants reported the current use of contraceptives, whether or not they Is there a significant association between age, mater- were sexually active was 54.9%. This is very similar to nal control (permissive vs. strict), decision self-esteem, the Hawaii Youth Risk Behavior Survey and Cross-Year decision-coping patterns, and adolescent contraceptive Comparisons (2007) that reported 54.2% of high school behavior? students used contraception at the last intercourse. Logistic regression was used to analyze the association When asked how often the participant used contra- between the independent variables: age, parental control, ception when sexually active, 39.2% said all the time. decision self-esteem, decision coping (vigilant and mal- Approximately 18% reported irregular use of contracep- adaptive), and the dependent variable contraceptive be- tives. This erratic use of contraception suggests there is havior. The logistic regression also used only those who an underlying factor affecting the competency in con- were sexually active at the time the survey was adminis- traceptive decision making. In the past, researchers have tered (n = 101). outlined factors that led to fewer competencies in deci- sion making, such as low academic skills, external locus Because of the multicollinearity between the decision of control, decrease in self-esteem, decreased future time self-esteem, decisional-coping vigilance, and decision- orientation, and poverty (Holden & Nelson, 1993; San- coping maladaptive, these variables were analyzed with dler, Watson, & Levine, 1992). Weinberger et al. (2005) age independently. There were no significant associa- proposed that less than mature frontal lobes of the brains tions between, age, parental control, decision self-esteem, of adolescents contribute to poor decision making, in re- decisional coping (vigilance and maladaptive), and sex- lation to estimating frequencies and probabilities. Stein- ually active participants and contraceptive use (see berg (2008) stated that adolescent risk taking is norma- Table 3). tive behavior, biologically driven, and inevitable. Casey, Getz, and Galvan (2008) discussed that there is consen- Discussion sus among developmental researchers that cognitive con- trol (inhibition) increases with age across childhood and In this study, parental control, decision self-esteem, adolescence. This increase is associated with maturation and decision coping (vigilant and maladaptive) were of the prefrontal cortex. This cognitive development af- examined in relation to sexual activity and contracep- fects the ability of adolescents to suppress inappropri- tive behavior. There were some points of interest in the ate thoughts and actions in favor of goal-directed ones. demographics of participants. The ages of participants in This is especially true in the presence of compelling in- this study were more in the middle range of adoles- centives (Casey et al., 2008). During the transitional pe- cence, which is the group most likely to be sexually active riod of adolescence, changes occur in the adolescent’s (Sexual Health of Adolescents, 2008). The sample was life, which can directly impact their decision-making multiethnic, with 42% reporting Hawaiian/part Hawai- competency. 568

K. Commendador Maternal parenting style Parental control that the participants were less likely to make impulsive hasty decisions and were less likely to procrastinate. Out The results of the PCS are described as a low of 13 (min- of all the scores, the higher scoring items on the scales re- imum behavioral control or maximum permissiveness) to flected panic in decision making or decisions were made a high of 52 (maximum restriction). Scores between 13 in a hurry. Lower scores reflected that the adolescent and 26 indicate low control; 27 and 39 moderate con- preferred to make her own decisions and put effort into trol; 40 and 45 firm control; and 46 and 52 strict control. making decisions. This is consistent with Piaget’s develop- The mean of 28.33 depicts a moderate level of parental mental theory of formal operational reasoning. As ado- control. lescents develop, they are able to engage in perspec- tive taking and reasoning about chance and probability, In looking at the individual items on the PCS, the low- and they are cognitively able to envision and evaluate est scoring items were related to being able to go any alternatives (Inhelder & Piaget, 1958). Adolescents need place they wanted to without asking and letting them time to go through the process of making a decision. do anything they wanted to do, demonstrating they had Unintended pregnancy, as surmised by Trad (2006), is a a fair amount of freedom. However, the higher scores result of the adolescents having difficulty in envisioning demonstrated that the adolescent felt the parent did not alternatives. These adolescents may have not yet reached give them as much freedom as they wanted, told them the state of formal operation reasoning, which supports exactly how to do their work, and that parents want the idea that adolescents need time and alternatives in or- to control everything they do. Approximately 50% of der to make competent decisions. The formal operator is the adolescents used contraception, which is an aver- able to see alternative solutions to a problem and is able to age number according to national statistics. This suggests hypothesize how personal actions result in various conse- that with a moderate level of maternal control of the quences (Inhelder & Piaget, 1958). These results are con- participants in this study, contraceptive use was aver- gruent with Janis and Mann’s (1977) conflict theory of age when compared to national statistics. This is fairly decision making. Those that have confidence and higher positive because studies have shown that less parental decisional self-esteem are associated with more vigilant monitoring predicted early sexual activity, less condom and less maladaptive decision making. use, and, for females, more sexual partners (Wight et al., 2006). The second research question revealed no significant relationship between female adolescents’ age, decision Decision self-esteem and decision-coping vigilance self-esteem and decision coping (vigilant and maladap- tive), and contraceptive behavior. This was different from As there are no normal or unusual scores reported in Commendador’s (2007), study which showed signifi- the literature for the FADMQ, these scores were inter- cant correlations between overall maladaptive scores and preted as moderate levels of decisional self-esteem and contraceptive use in adolescents and Ormond et al.’s decision-coping vigilance. In the decisional self-esteem (1991) study that revealed increased age was signif- scale, the items that scored lowest indicated poor deci- icantly correlated with higher levels of decision self- sion making. The items that scored the lowest reflected esteem and decision-coping vigilance and lower levels that the adolescent felt she was not as good as most peo- of maladaptive decision making. The findings of this ple in making decisions and she did not feel her decisions study showed multicollinearity between decision self- turned out well, indicating a lack of confidence in her de- esteem, decision-coping vigilance, and decision-coping cision making. However, higher scores showed that once maladaptive scales. Similar findings of multicollinearity she made a decision she did not change her mind and were also noted by Commendador’s (2007) study of self- she likes to think about a decision before she makes it. esteem and adolescent decision-coping patterns in ado- This seems to follow a trend of adolescents not quite feel- lescents in Hawaii. Seemingly, as the scales of global self- ing competent in their decision making, which is congru- esteem, decisional self-esteem, and decision-coping vigi- ent with Mann et al.’s (1989) findings suggesting that as lance went up, depicting more competent and confident adolescents age across middle adolescence, they become decision making, the scores of the maladaptive scale went more competent decision makers. down, meaning they were less likely to be poor decision makers. This is also congruent with Janis and Mann’s Decision-coping maladaptive (1977) conflict theory and previous research studies us- ing this theory (Friedman & Mann, 1993; Hollen, 1998; Higher scores on the maladaptive scale constitute less Johnson, 1994, Okwumabua & Wong, 2003; Ormond competent decision making. The decision-coping mal- et al., 1991). There were, however, significance posi- adaptive scores were on the lower side, demonstrating tive correlations between age and parental control. This 569

Maternal parenting style K. Commendador suggests that as the adolescent ages, the maternal parent- outcome analysis. Another consideration is that another ing style becomes more controlling. Wight et al. (2006) conceptual framework may fit exploring adolescent deci- suggest there is a reverse causation of parenting styles. sion making such as the Transtheoretical Change Model If the adolescent is engaging in risky behavior, no mat- and the concept of decisional balance used by Chambers ter what the age, then the parent becomes more con- and Rew (2003). trolling. There were also significant positive correlations between more controlling mothers and decision-coping Nursing implications complacency. This style of decision coping means that the adolescent ignores information about risks and losses Adolescence is a time of life when there are deci- and decides to continue the present course of action or sions made with little experience. These decisions can choose whatever course of action is suggested. Ferrari and have lifelong consequences. While this study did not Olivette (1993) noted more chronic indecision tenden- show there were associations and correlations between cies in higher controlling parents. This suggests that these parenting styles and contraception, it did show there was adolescents of controlling mothers are not as active in the a correlation between maternal parenting styles and com- decision-making process. placency in decision coping. It also showed that maternal parenting styles were more controlling as the adolescent Results for the third question revealed no associ- aged. It suggests that as the adolescent ages, there is an ation between age, maternal parenting style, global increase in strict or controlling parenting styles that can self-esteem, decision self-esteem, decision coping (vigi- affect decisional coping in a way that is a deterrent to- lant and maladaptive), and contraceptive use. These find- ward active decision making. With complacency, the de- ings do not support the maladaptive coping part of Janis cision maker ignores information about the risk of losses and Mann’s (1977) theory of vigilant (adaptive) and mal- and decides to continue the present course of action. The adaptive decision making. This is also not consistent with decision maker simply just sticks to what they have been previous research studies using Janis and Mann’s model doing. (Commendador, 2007; Friedman & Mann, 1993; Hollen, 1998; Johnson, 1994; Okwumabua & Wong, 2003; Or- Nurse practitioners (NPs) have the opportunity to take mond et al., 1991) that those who scored higher on the an active role in facilitating competent decision making. maladaptive scale were less competent or poorer decision The NP can provide education and anticipatory guidance makers. to mothers with adolescents. Strategies can be developed with mothers on how to enhance decision making via Several other independent variables, although not sta- role playing and designing hypothetical situational de- tistically significant, showed a trend toward the direction cisional trees to use with their adolescents. The goal is of significance (decision-coping panic p = .180; maladap- not to change the parenting style but to enhance the tive coping p = .221; parental control p = .257). This leads mother’s skills toward adolescent participation in active one to believe that if the sample size were larger, asso- decision making. Practicing different situations that re- ciations may have emerged between maladaptive deci- quire decision making will give the adolescent experience sion coping, parental control, and contraceptive decision in decision making and its consequences. Open maternal making. communication has been widely studied over the last 20 years. Mothers’ conversations with their adolescents can Limitations make an impact despite this age of high technological ad- vancement. Encouraging mothers to continue with these The sample size was appropriate via the projections of conversations with their adolescents will enhance con- the power analysis; however, the small sample size may nectedness with the parent and decision making. Perhaps have affected the outcome of the analysis. The informa- discussion of sexuality and sexual decision making should tion obtained from this study was based on a self-report be incorporated in the education system and be part of survey that could be linked to potential biases related to the healthcare providers’ educational practice and of pe- social needs and social desirability. As this was a conve- diatric clinics handling older school age children. Discus- nience sample of female adolescents seeking health care sion between NPs and mothers and daughters could foster in rural areas on the Big Island of Hawaii and Maui, interchange around sexuality such as pubertal develop- the results may not be generalizable to all adolescents in ment, changing body, decision making as to sexual activ- other communities. The Sexual History and Contracep- ity, and contraception. tive Use Questionnaire designed for this study was piloted only once before in a previous study to determine clarity. The progression of adolescent competence in decision The small sample size of participants who were sexually making is a developmental maturational process. As ado- active at the time of the survey may have affected the lescents develop they are capable of rational decision 570

K. Commendador Maternal parenting style making to achieve their goals. However, many decisions Acknowledgments are made in situations of heated passion, peer influence, on the spur of the moment, in unfamiliar situations, and The author wishes to thank Planned Parenthood of when behavior inhibition is required for good outcomes. Maui and Kona, Hamakua Health Center, and the When brain maturation is not complete, adolescent de- Waimea Women’s Center for their help in this project. cision making tends to be impulsive, sensation seeking, The opinions expressed in this article do not necessar- and thrill seeking that contributes to risk taking. A short ily reflect those of Planned Parenthood Federation of intervention in an office visit, such as role playing while America, Inc. waiting for a pregnancy test result, can help adolescents see consequences. Discussing with the adolescent “What References if” scenarios, such as “What if this pregnancy test is posi- tive” can help the adolescent envision some of the conse- Aquilino, M. L., & Bragadottir, H. (2000). Adolescent pregnancy: Teen quences of unprotected intercourse. perspectives on prevention. Maternal-Child Nursing, 25, 192–197. Adolescents who perceive interactions with their Bednar, D. E., & Fisher, T. D. (2003). Peer referencing in adolescent decision healthcare provider as being coercive may feel they are making as a function of perceived parenting style. Adolescence, 38, 607–620. changing behaviors for the healthcare provider and not themselves. Conversations with adolescents about why Berry, G. (2000). Multicultural media portrayals and changing demographic they want to change their behavior may be more suc- landscape: The psychosocial impact of television representations on the cessful in behavioral change. It is important to respect the adolescent of color. Journal of Adolescent Health, 27, 35–44. adolescent’s autonomy and collaborate with adolescents in decision making. Bonell, C., Allen, E., Sfrange, V., Oakley, A., Copas, A., Johnson, A., & Stephenson, J. (2006). Influence of family type and parenting behaviours The literature provides positive and negative results for on teenage sexual behaviour and conceptions. Journal of Epidemiology and both controlling and permissive parenting styles. It is im- Community Health, 60, 502–506. portant for parents to determine how closely to monitor their adolescent and consider the potential positive and Borawski, E., Ievers-Landis, C., Lovegreen L., & Trapi, E. (2003). Parental negative results associated with each monitoring level. monitoring, negotiated unsupervised time, and parental trust: The role of The NP can educate parents about these different levels perceived parenting practices in adolescent health risk behaviors. Journal of so that parents can obtain a balance between parental in- Adolescent Health, 33, 60–70. teractions and quality relationships that are important in the adolescent development. Brooks-Gunn, J., & Furstenberg, F. (1989) Adolescent sexual behavior. American Journal of Psychology, 64, 249–257. Finally, NPs need to engage in more research to gen- erate theories about adolescent decision making and Brooks-Gunn, J., & Paikoff, R. L. (1991). Promoting health behavior in contraceptive behavior. Research suggests that there adolescence: The case of sexuality and pregnancy. Bulletin of New York are many influences on adolescent decision making Academy of Medicine, 67, 427–547. and contraceptive behavior but few have actually been researched. Brown, J. (2000). Adolescents media diets. Journal of Adolescent Health, 27, 35–44. Conclusion Browning, C. R., Burrington, L. A., Leventhal, T., & Brooks-Gunn, J. (2008). Teen pregnancy is on the rise and a national public Neighborhood structural inequality, collective efficacy, and sexual risk health concern. While this study has limitations, it did behavior among urban youth. Journal of Health and Social Behavior, 49, highlight one aspect of Janis and Mann’s (1977) con- 269–285. flict theory. There was a correlation between parenting style and complacent-coping decision making. Given that Casey, B. J., Getz, S., & Galvan, A. (2008). The adolescent brain. Developmental teens have reported that their parents have the most in- Review, 40, 1321–1328. fluence on their sexual behaviors, it would be useful to conduct further research on how parents address or do Chambers, K. B., & Rew, L. (2003). Safer sexual decision making in adolescent not address their teens’ sexual behavior over time. In women: Perspectives from the conflict theory of decision-making. Issues in order to reduce the rate of teen pregnancy, adolescents Comprehensive Pediatric Nursing, 26, 129–132. need help in making competent decisions so that they can make the right choices. Commendador, K. (2003). Concept analysis of adolescent decision making and contraception. Nursing Forum, 38, 27–35. Commendador, K. (2007). The relationship between female adolescent self-esteem, decision making and contraception. Journal of the American Academy of Nurse Practitioners, 19, 614–623. Conger, K. J., Conger, R. D., & Scaramella, L. V. (1997). Parents, siblings, psychological control, and adolescent adjustment. Journal of Adolescent Research, 12, 113–138. Dangal, G. (2006). An update on teenage pregnancy. Internet Journal of Gynecology and Obstetrics, 5, 3–3. DiClemente, R. J., Wingood, G. M., Crosby, R., Cobb, B. K., Harington, K., & Davies, S. (2001). Parent-adolescent communication and sexual risk behaviors among African American adolescent females. Journal of Pediatrics, 129, 407–412. Dilorio, C., Kelley, M., & Hockenberry-Eaton, M. (1999). Communication about sexual issues: Mothers, fathers, and friends. Journal of Adolescent Health, 24, 181–189. Dittus, P. J., & Jaccard, J. (2000). Adolescents’ perceptions of maternal disapproval of sex: Relationship to sexual outcomes. Journal of Adolescent Health, 26, 268–278. Doswell, W. M., Kim, Y., Braxter, B., Taylor, J., Kitutu, J., & Hsu, Y. A. (2003). A theoretical model of early teen sexual behavior: What research tells us 571

Maternal parenting style K. Commendador about mother’s influence on the sexual behavior of early adolescent girls. among urban minority adolescent girls: The crisis at sexual debut. Annals of Journal of Theory Construction and Testing, 7, 56–60. Family Medicine, 6, 549–554. Fasula, A. M., & Miller, K. S. (2006). African-American and Hispanic McNeely, C., Shew, M., Beuhring, T., Sieving, R., Miller, B., & Blum, R. adolescents’ intentions to delay first intercourse: Parental communication (2002). Mothers influence on the timing of first sex among 14 and 15 year as a buffer for sexually active peers. Journal of Adolescent Health, 38, olds. Journal of Adolescent Health, 31, 256–265. 193–200. Miller, B. C. (2002). Family influences on adolescent sexual and contraceptive Ferrari, Jo. R., & Olivette, M. J. (1993). Perception of parental control and the behavior. Journal of Sex Research, 39, 22–26. development of indecision among late adolescent females. Adolescence, 28, Miller, K. S., Kotchick, B. A., Dorsey, S., Forehand, R., & Ham, A. Y. (1998). 963–970. Family communication about sex: What are parents saying and are their Friedman, I. A., & Mann, L. (1993). Coping patterns in adolescent adolescents listening. Family Planning Perspectives, 30, 218–235. decision-making: An Israeli-Australian comparison. Journal of Adolescence, Miller, K. S., & Whitaker, D. J. (2001). Predictors of mother-adolescent 16, 187–199. discussions about condoms: Implications for providers who serve youth. Gage, A. J. (1998). Sexual activity and contraceptive use: The components of Pediatrics, 108, E28. the decision making process. Studies in Family Planning, 29, 254–166. National Campaign To Prevent Teen Pregnancy. (2008a). Teen sexual activity in Guttmacher, A. (2004). U.S. teenage pregnancy statistics, national and state the United States. Retrieved from http://www.thenationalcampaign. trends and trends by race and ethnicity. Retrieved from org/national-data/pdf/TeenSexActivityOnePager.pdf http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf National Campaign To Prevent Teen Pregnancy. (2008b). Teen births: Examining Guttmacher, A. (2006). Facts of America’s teens’ sexual and reproductive the recent increase. Retrieved from http://www.teenpregnancy.org health. Retrieved from http://www.guttmacher.org/pubs/fb ATSRH.html Okwumabua, J. O., & Wong, S. P. (2003). Depressive symptoms and decision Hawai‘i Youth Risk Behavior Surveys and Cross-Year Comparisons. (2007). making among African American youth. Journal of Adolescent Research, 18, University of Hawaii; College of Education. Retrieved from 436–453. http://hawaii.gov/health/about/reports/2007-YRBS-Results.pdf Ormond, C., Luszcz, M. A., Mann, L., & Beswick, G. (1991). A metacognitive Hoffman, S. (2006). Cost of teen pregnancy. Retrieved from analysis of decision making in adolescence. Journal of Adolescence, 3, http://www.thenationalcampaign.org/costs/default.aspx 275–291. Holden, G. W., & Nelson, P. B. (1993). Cognitive, psychosocial, and reported Roche, K. M., Mekos, D., Alexander D., Astone, N. M., Bandeen–Roche, K., & sexual behavior differences between pregnant and nonpregnant Ensminger, M. E. (2005). Parenting influences on early sex initiation adolescents. Adolescence, 28, 557–573. among adolescents: How neighborhood matters. Journal of Family Issues, 26, Hollen, P. J. (1998). Intervention booster: Adding a decision-making model to 32–54. risk reduction and other health care programs for adolescents. Journal of Rohner, R. P., & Khaleque, A. (2005). Handbook for the study of parental Pediatric Health Care, 12, 247–255. acceptance and rejection. Storrs, CT: Rohner Research Publications. Huebner, A. J., & Howell, L. W. (2003). Examining the relationship between Romer, D., Stanton, B., Galbraith, J., Feigelman, S., Black, M. M., & Li, X. adolescent sexual risk-taking and perception of monitoring, (1999). Parental influence on adolescent sexual behavior in high-poverty communication, and parent styles. Journal of Adolesent Health, 33, 71–78. settings. Archives of Pediatric & Adolescent Medicine, 153, 1055–1062. Inhelder, B., & Piaget, J. (1958). The growth of logical thinking from childhood to Romo, L. F., Lefkowitz, E. S., Sigman, M., & Au, T. K. (2002). A longitudinal adolescence (A. Parsons, Trans.). New York: Basic Books. study of maternal messages about dating and sexuality and their influence Janis, I. L., & Mann, L. (1977). Decision making: A psychosocial analysis of conflict, on Latino adolescents. Journal of Adolescent Health, 31, 59–69. choice and commitment. New York: Free Press. Sandler, A. D., Watson, T. E., & Levine, M. D. (1992). A study of the cognitive Jemmott, J. B., Jemmot, L. S. III, & Fong, G. (1998). Abstinence and safer sex aspects of sexual decision making in adolescent females. Journal of HIV risk-reduction interventions for African-American adolescents: A Developmental and Behavioral Pediatrics, 13, 202–207. randomized control trial. Journal of the American Medical Association, 279, Santelli, J., Ott, M., Lyon, M., Rogers, J., Summers, D., & Schleifer, J. D. 1529–1536. (2006). Abstinence and abstinence-only education: A review of U.S. Johnson, S. B. (1994). Decision making styles and fact finding. Paper presented at policies and programs. Journal of Adolescent Health, 38, 72–81. the meeting of the Australian Association for Research, New South Wales. Schaefer, E. S. (1965). A configurational analysis of children’s reports of Sexual Health of Adolescents and Young Adults in the United States parent behavior. Journal of Consulting Psychology, 29, 552–557. (2008). Kaiser Family Foundation. Retrieved from www.kff.org Sieving, R. E., McNeely, C. S., & Blum, R. W. (2000). Maternal expectations, Kaiser Family Foundation. (2008). Sexual health of adolescents and young adults in mother-child connectedness, and adolescent sexual debut. Archives of the United States. Retrieved from www.kff.org Pediatric Adolescent Medicine, 154, 809–816. Kirby, D. (2001). Understanding what works and what doesn’t in reducing Simanski, J. W. (1998). The birds and the bees: An analysis of advice given to adolescent sexual risk taking. Family Planning Perspectives, 33, 276–281. parents through popular press. Adolescence, 33, 33–46. Kirby, D. (2007). Emerging answers, 2007. Retrieved from Steinberg, L. (2005). Adolescence (7th ed.). Boston: McGraw-Hill. http://search.thenationalcampaign.org/?index=433175&query= Steinberg, L. (2008). A social neuroscience perspective on adolescent abstinence&image.x=7&image.y=15 risk-taking. Developmental Review, 28, 78–106. Kirby, D. (2008). The impact of abstinence and comprehensive sex and Trad, P. V. (2006). Developmental previewing: Enhancing the adolescent’s STD/HIV reduction programs on adolescent sexual behavior. Sexuality predictions of behavioral consequences. Journal of Clinical Psychology, 6, Research and Social Policy, 5, 6–17. 814–829. Lagana, L. (1999). Psychosocial correlates of contraceptive practices during late Weinberger, D. R., Elvevag, B., & Giedd, J. N. (2005). The adolescent brain: A adolescence. Adolescence, 34, 463–483. work in progress. Retrieved from http://www.Teenpregnancy.org Mann, L., Harmoni, R., & Power, C. (1989). Adolescent decision-making: The Wight, D., Williamson, L., & Henderson, M. (2006). Parental influences on development of competence. Journal of Adolescence, 12, 265–278. young people’s sexual behavior: A longitudinal analysis. Journal of Mann, L., Harmoni, R., Power, C., Beswick, G. & Ormond, C. (1988). Adolescence, 29, 473–494. Effectiveness of the GOFER course in decision making for high school Woods, J. L., Shew, M. L., Tu, W., Ofner, S., Ott, M. A., & Fortenberry, J. D. students. Journal of Behavioral Decision Making, 1, 159–168. (2006). Patterns of oral contraceptive pill-taking and condom use among McKee, M. D., Karasz, A. L., & Weber, C. M. (2004). Health care seeking adolescent contraceptive pill users. Journal of Adolescent Health, 39, 381–387. 572