Sexual minority adolescents: Understanding disparities in sex education and parent communication about sex

Thesis advisor: Susan Kelly-WeederBackground: Sexual minority youth experience many sexual health inequities compared to heterosexual youth. Research conducted over the past several decades has concluded that both parent-adolescent sex communication and school-based sex education are effective in reducing levels of sexual risk behavior in heterosexual youth. A much smaller number of studies have examined the experiences and effectiveness of sex education or PASC among sexual minority youth. Purpose: This three-manuscript dissertation seeks to extend understanding about the experiences of sexual minority and heterosexual youth with learning about sex and sexuality at school and at home and how these learning experiences affect sexual risk behavior. The purpose of this dissertation is to examine parent-adolescent sex communication from the perspective of sexual minority youth and their parents, assess the impact of different types of sex education on sexual intercourse and contraceptive behavior of sexual minority and heterosexual adolescent females, and revise and extend a scale designed to measure sexual minority youth perceptions of sexual-minority-inclusivity in sex education. Methods: In the first manuscript, we conducted an integrated review that described how parents and SGM youth perceive their sex communication experiences and synthesized findings about the associations between parent-adolescent sex communication and sexual health outcomes among SGM youth. In the second manuscript, we used National Survey of Family Growth data to describe the total sex education content received by an individual, examine the impact of different sex education types on sexual intercourse and contraceptive behavior of adolescent females, and examine differences by sexual identity. In phase one of the last study, we revised a scale to measure SMYA perceptions of sexual minority-inclusivity in school-based sex education received before the age of 18 years. Phase two involved implementing a pilot study to measure the reliability and conduct a Rasch analysis of the revised scale. Results: The integrated review results suggest that parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education/guidance is lacking. Secondary data analysis results suggest that compared to their heterosexual peers, sexual minorities were more likely to report no sex education and less likely to report receipt of abstinence-only education. Nearly all types of education had a statistically significant effect on sexual behavioral outcomes (intercourse in the past 12 months and type of contraceptive use) as compared to no sex education. Scale revision and psychometric analyses suggested that the new scale has strong psychometric properties, including reliability, content validity, and measurement precision. Conclusion: Overall, this dissertation has highlighted the ways that home and school-based sources of sexual health information do not currently meet the needs of SM youth. The sexual health education of SM youth is complicated by a lack of comfort, knowledge, and resources experienced by both teachers and parents. Qualitative studies suggest that both sources of sexual health information tend to be focused on heterosexual needs, leaving SMY feeling frustrated and invisible. This dissertation has also highlighted the need for quantitative measures to extend understanding of the impact of parent-adolescent sex communication and sex education on sexual minority youth. The revised scale presented in Chapter 4 provides a promising measurement tool to inform the development and evaluation of sexual minority-inclusive sex education programs. The results of this dissertation will ultimately contribute to the development of programs and interventions to support SM-inclusivity in school-based, family-based, and healthcare provider-based sexual health education. Thesis (PhD) — Boston College, 2022.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing