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Objectives: The past decade has seen changes in US HIV policy in sub-Saharan Africa in response to a new Administration and far-reaching technical, scientific and programmatic developments. These include dramatically increased access to life-saving anti-retroviral therapy (ART) and related services, the roll-out of voluntary medical male circumcision and growing sensitivity to gender-based violence, including child sexual abuse, and to its role in increasing vulnerability to HIV. The "Families Matter! Program" (FMP) is an intervention for parents and caregivers of 9- to 12-year-olds that promotes effective parent-child communication about sexuality and sexual risk reduction. FMP was adapted from a US evidence-based intervention in 2003-2004 and is now implemented in eight African countries. In 2012-2013, the FMP curriculum was updated and enhanced to respond to new US Government priorities. Methods: Enhancements to the curriculum drew on the results of Violence Against Children surveys, on a review of existing literature, on feedback from the field on the existing curriculum and on stories written by young people across Africa for scriptwriting competitions. Methods: Enhancements to the curriculum drew on the results of Violence Against Children surveys, on a review of existing literature, on feedback from the field on the existing curriculum and on stories written by young people across Africa for scriptwriting competitions. Results: We updated FMP with scientific content and stronger linkages to services. We also intensified our focus on structural determinants of risk. This contextualisation of sexual risk-taking within structural constraints led us to place greater emphasis on gendered vulnerability and the diverse pressures children face and to intensify our situation-based pedagogical approach, drawing on the authentic youth-authored narratives. Conclusion: We describe these changes as an illustration of and source of insight into much-needed programmatic adaptation in response to evolving HIV policy.

Understanding of preadolescent sexuality is limited. To help fill this gap, we calculated frequencies, percentages, and confidence intervals for 1,096 preadolescents' reports of sexual thoughts, intentions, and sexual behavior. Cochran-Armitage trend tests accounted for age effects. Findings show that 9-year-olds are readying for sexual activity, with sexual readiness increasing between ages of 9 and 12. Sexual thoughts increased with age (p less than 0.001): 46% of 9-year-olds and 70% of 12-year-olds were ready to learn about sex, and 14% of 9-year-olds and 41% of 12-year-olds thought about having sex. Few 9-year-olds anticipated sexual debut, but this increased with age (p less than 0.05): 25% of 12-year-olds were ready for sex, and 20% anticipated initiating sex within a year. Our results indicate that preadolescents are initiating dating relationships and anticipating intercourse, and some have engaged in risk behaviors. Thus preadolescence is a critical time to implement prevention programs. (Contains 1 table.)

We examine efficacy of the Parents Matter! Program (PMP), a program to teach African-American parents of preadolescents sexual communication and HIV-prevention skills, through a multicenter, randomized control trial. A total of 1115 parent-child participants were randomized to one of three intervention arms (enhanced, brief, control). Percentages and 95% confidence intervals compare parents' perception of child readiness to learn about sexual issues, communication effectiveness, and dyad concordance from baseline to 12 months postintervention. Wilcoxon rank sum tests compare the changes in scores measuring communication content in HIV/AIDS, abstinence, and condom use. Compared to control, parents in the enhanced arm increased perception of child readiness to learn about sex (16% vs. 29%; p less than 0.001), and a greater proportion of parent-child dyads reported concordant responses on communication topics: HIV/AIDS (15%, 95% CI = 8-21%; p less than 0.001), abstinence (13%, 95% CI = 7-20%; p less than 0.001), condoms (15%, 95% CI = 9-22%; p less than 0.001). Increases in communication scores in HIV/AIDS, abstinence, and condom use were greater in the enhanced arm than control (p less than 0.01). We conclude that the enhanced PMP can help parents educate children about HIV and prepare children to avoid sexual risk.

Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents' Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = 0.68, CI:0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success.

Evidence-based interventions (EBIs) are critical for effective HIV prevention, but time and resources required to develop and evaluate new interventions are limited. Alternatively, existing EBIs can be adapted for new settings if core elements remain intact. We describe the process of adapting the Parents Matter! Program, an EBI originally developed for African American parents to promote effective parent-child communication about sexual risk reduction and parenting skills, for use in rural Kenya. A systematic process was used to assess the community's needs, identify potential EBIs, identify and make adaptations, pilot-test the adapted intervention, and implement and monitor the adapted EBI. Evaluation results showed the adapted EBI retained its effectiveness, successfully increasing parent-child sexual communication and parenting skills. Our experience suggests an EBI can be successfully adapted for a new context if it is relevant to local needs, the process is led by a multidisciplinary team with community representation, and pilot-testing and early implementation are well monitored.

We evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan program.

The purpose of the current study was to examine communication about sexual topics between preadolescents and their mothers and fathers. Participants were 135 African-American mothers, fathers, and their 9- to 12-year-old offspring. Each member of the triad completed a 10-item measure of communication about risk factors for sexual activity, sexual communication, and sexual risk prevention. A majority of parents and their preadolescents reported communication had occurred about most topics. Mothers and fathers were equally likely to communicate with sons whereas mothers were more likely to communicate with daughters than were fathers. Based on the study results, preadolescence may be the optimal time for parents to provide sexual risk prevention messages to their children before sexual behaviors are initiated.

The purpose of the research was to examine whether perceived peer dating and sexual experience norms are related to attitudes toward dating and sexual behavior and to precoital and sexual intentions among African American preadolescents. Participants included 1,046 African American youth aged 9-12 years (M = 10.57 years). Youth completed a baseline survey as part of a larger intervention study. Perceived peer norms regarding dating and sexual experience were positively related to youth attitudes toward dating and sexual behavior. Youth who perceived their peers as not engaging in sexual activity were less likely to have precoital or sexual intentions. The relationships were not moderated by gender of the preadolescent. Findings from this study suggest that addressing peer norms around dating and sexual activity among preadolescent African American youth may be important for prevention efforts aimed at encouraging abstinence and the delay of sexual activity.

A randomly selected nationally representative sample of 508 practicing pediatricians was surveyed in order to identify factors associated with physician delivery of primary prevention to parents about sexual risk reduction (SRR). A full 86% (n=435) reported that provision of SRR guidance is equally or more important than other guidance provided to parents. Among the 435, only 121 (28%) provided SRR guidance to greater than 75% of parents of their adolescent patients. Multivariate analyses revealed barriers of: lack of training, lack of request from parents, and awkwardness. To promote parent-child communication, physicians suggested high-quality brochures for parents (84%); a list of resources (74%); and tools to facilitate parent-child discussions (63%). Pediatricians and parents are important components of sexual risk prevention efforts for adolescents. Editors' Strategic Implications: The findings related to the perceived importance but infrequent delivery of SRR communication between pediatricians and parents of adolescents have implications for training and information dissemination in pediatric practices, as well as other health and reproductive health settings.

This study examined if pre-intervention maternal gender role beliefs predict change in sexual communication in a sexual risk behavior prevention program designed to increase parent--pre-adolescent communication about sex. A sample of 281 African American fourth and fifth graders and their mothers participated in the five-session program and completed computerized questionnaires at baseline, postintervention, and 6-month follow-up. Based on mother report, more egalitarian maternal gender role beliefs predicted greater increases in parent--pre-adolescent communication about sex at postintervention. Based on pre-adolescent report, similar findings emerged at the 6-month follow-up, but only for boys. The relationship of maternal gender role beliefs to changes in sexual communication was not accounted for by maternal comfort with sexual communication with their pre-adolescents. The implications of maternal gender role beliefs in a prevention program designed to increase communication about sexual topics are considered. (Contains 2 tables.)

We present a discussion of some of the lessons the investigators learned during the development and implementation phases of the Parents Matter! Program (PMP). Lessons were learned that are relevant to various groups involved in large scale, multi-site, community-based intervention studies: investigators, community leaders, community members, project staff, and participants. Specific lessons learned include: (1) forge collaboration early: (2) maintain communication; (3) clearly delineate policies and procedures; and (4) develop proactive strategies. We also include a list of important questions to consider when contemplating similar projects.

The Parents Matter! Program (PMP) is a community-based family intervention designed to promote positive parenting and effective parent-child communication about sexuality and sexual risk reduction. Its ultimate goal is to reduce sexual risk behavior among adolescents. PMP offers parents instruction and guidance in general parenting skills related to decreased sexual risk behavior among youth (e.g., relationship building, monitoring) and sexual communication skills necessary for parents to effectively convey their values and expectations about sexual behavior--as well as critical HIV, STD, and pregnancy prevention messages--to their children. We briefly review the literature concerning parental influences on adolescent sexual risk behavior and present the conceptual model and theoretical foundation upon which PMP is based.

Sexually transmitted infections, including human immunodeficiency virus (HIV), disproportionately affect African American adolescents and young adults. Many of our current strategies and approaches have been inadequate in the promotion of risk reduction among youth and need to be reconceptualized. This article identifies issues that may guide researchers to better address the risks faced by African American youth. Some of these issues include tailoring of intervention messages and programs, timing of intervention delivery, consideration of contextual factors that influence risk behaviors, and increasing the breadth of our intervention focus. Discussions of how these strategies and approaches may enhance intervention effectiveness are highlighted.

Examined how parent-adolescent communication about initiating sex and using condoms influenced the relationship between peer norms and behavior among African American and Hispanic adolescents. Found that peer norms were more strongly related to behavior among adolescents who had not discussed sex or condoms. Communication was also related to teens naming a parent as the best information source about sex. (Author/KB)

Black and Hispanic adolescents (N=907) and their mothers were interviewed concerning the adolescents' experiences with penile-vaginal intercourse. Factors from three systems (self, family, and extrafamilial) that are influential in the lives of adolescents were evaluated using four outcome measures. Factors from most or all systems emerged as predictors of each outcome measure. (Author/MKA)

This study explored the sexual double standard (SDS) (in which males are afforded more freedom and power than females in heterosexual interactions) in African American mothers' sexual messages to sons and daughters. We used a convenience sample of 129 African American adolescents, aged 14 to 17 years, and their mothers who reported SDS attitudes. Qualitative analyses revealed gender differences based on an SDS in mothers' sexual risk reduction socialization. Mothers typically took a proactive approach with sons and a neutral or prohibitive approach with daughters. Findings provide directions for socially relevant programs for African American parents, schools, and communities. doi:10.1300/J013v46n02_02 KEYWORDS. Sexual socialization, sexual risk reduction, African American, adolescent, gender