1. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
1
A
Culturally
Appropriate
Sexual
Education
Intervention
for
Parents
of
Middle
School
Latino
Students
Domenica
Nino
Emory
University
Adolescent
Health
Professor
Sales

2. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
2
Abstract
Even
though
evidence-­‐based
interventions
exist
to
improve
parental
communication
between
teens
and
parents,
there
is
a
lack
of
culturally
appropriate
evidence-­‐based
interventions
that
target
Latino
parents.
The
Latino
population
is
an
especially
important
population
to
study
since
it
suffers
from
high
rates
of
teenage
pregnancy
and
STDs
(National
Campaign
to
Prevent
Pregnancy,
2012).
The
proposed
intervention
utilizes
the
socio-­‐cognitive
theory
and
the
social
learning
theory
to
reduce
sexual
risk
behaviors
through
the
improvement
of
parental-­‐adolescent
communication
in
Latino
families.
The
culturally
appropriate
intervention
aims
to
teach
Spanish
Speaking
Latino
parents
of
middle
school
students
(ages
11-­‐14)
how
to
effectively
communicate
sexual
education
to
their
teens.
The
intervention
will
consist
of
one
3-­‐hour
session
and
four
follow-­‐up
phone
calls
throughout
the
span
of
twelve
months.
Throughout
the
intervention,
telenovela-­‐style
clips
to
are
used
to
model
effective
communication
strategies
to
Latino
parents.
The
session
will
be
led
by
a
Latino
health
educator
that
will
focus
on
effective
communication
and
parental
monitoring
strategies
to
delay
the
onset
of
sexual
intercourse
in
the
young
Latino
adolescent
population.
Effectiveness
will
be
measured
through
questionnaires
conducted
with
teens
pre
intervention
and
three
and
twelve
months
post
interventions
and
will
measure
parent-­‐adolescent
communication,
parental
monitoring
and
supervision,
perceived
parental
expertise
about
sex
education,
and
sexual
behavior.

3. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
3
Introduction
Adolescence
is
an
exciting,
yet
confusing
period
of
life.
During
that
period,
behaviors
are
established
and
decisions
are
made
that
can
greatly
influence
the
immediate
and
future
health
outcomes
of
the
teenager.
It
is
important
that
parents
understand
the
positive
impact
that
effective
parental
communication
can
have
in
their
teenagers
while
they
make
the
transition
into
adulthood.
During
adolescence,
parents
are
strategically
positioned
to
help
their
teenagers
successfully
overcome
this
difficult
period
of
life
through
the
establishment
of
successful
communication
patterns
specifically,
in
aiding
their
teens
in
making
smart
choices
about
their
sex
life.
Even
though
it
is
important
for
all
parents
to
improve
their
parental
communication
skills
during
this
period,
it
is
especially
imperative
that
at-­‐risk
minority
groups
are
provided
with
the
tools
they
need
to
assist
their
children
through
their
teenage
years.
The
proposed
intervention
focuses
on
decreasing
teen
sexual
risk
behaviors
by
increasing
parental
communication
in
Latino
parents
of
middle
school
students
through
a
culturally
appropriate
one-­‐time
intervention.
Research
has
shown
that
if
teenagers
are
targeted
and
taught
about
sex
before
their
sexual
debut,
they
will
be
more
likely
to
delay
time
of
first
intercourse
and
to
have
reduced
sexual
risk
behaviors,
like
increased
condom
usage,
once
they
become
sexually
active
(
O’Donnel,
et
al.,
2005).
Using
a
culturally
sensitive
approach,
the
proposed
intervention
will
use
socio-­‐cognitive
theory
and
the
social
learning
theory
to
affect
behavior
of
Latino
parents
through
their
exposure
to
desired
modeled
behaviors
that
are
culturally
tailored
to
the
values
and
morals
of
the
Latino
population.
With
the
help
of
this
intervention,
parents
can
overcome
barriers
and
talk
to
their
children
about
sex.
For
example,
using
Latino
values
such
as
Familismo
and
Respeto,

4. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
4
along
with
education
and
incorporating
cultural
traditions
like
watching
telenovela
style
clips,
will
provide
parents
with
the
education
necessary
to
teach
their
children
about
sexual
education.
Providing
parents
with
information
about
safe
sex
practices
for
their
children,
along
with
equipping
them
with
culturally
appropriate
teachable
moments,
will
provide
great
opportunities
for
Latino
parents
to
impart
sexual
education
to
their
children.
Background
Literature
The
Latino
population
is
currently
growing
at
an
astounding
rate.
The
Latino
teen
population
grew
more
than
forty
percent
between
the
years
of
1990
and
2002
and
is
expected
to
increase
to
an
additional
fifty
percent
by
the
year
2025
(Kaiser,
2008).
Thus,
it
is
important
that
prevention
measures
are
taken
to
decrease
sexual
risk
behaviors
within
the
Latino
population.
There
exist
a
variety
of
risk
factors
that
are
specific
to
the
Latin
community.
Some
which
include
acculturative
stress,
perceived
discrimination,
and
traditional
gender
roles.
Traditional
gender
roles
play
an
important
part
in
what
sexual
values
Latino
parents
choose
to
impart
in
their
children.
There
exist
opposing
values
regarding
sexual
gender
roles
in
the
Latino
culture,
and
such
values
are
termed
Marianismo
and
Machismo.
Marianismo
refers
to
female
gender
values
where
women
are
venerated
for
their
purity
and
moral
values,
thus
placing
a
great
emphasis
on
the
value
of
virginity.
On
the
other
hand,
machismo
refers
to
an
extravagant
sense
of
manliness
in
which
virility,
courage,
strength
and
entitlement
shape
men’s
gender
roles
in
society
(Stephens,
1977).
The
opposing
values
of
Latino
culture
can
contribute
to
the
sexual
risk
behaviors
of
the
adolescents.
Helping
parents
understand
the
effects
of
opposing
gender
values
might
encourage
them
to
overcome
the
communication
barriers
about
sex
and
provide

5. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
5
appropriate
sexual
education
to
both
genders.
In
addition,
there
is
a
strong
sense
of
family
and
community
termed
familismo,
which
provides
protective
factors
to
Latinos
as
well.
Research
demonstrates
that
health
communication
efforts
for
Latinos
need
to
focus
on
family,
cultural
traditions,
and
collectivism
while
attending
to
acculturation,
language,
generation
and
national
origin
(Elder
et
al.,
2009).
Thus,
connecting
a
cultural
understanding
with
adequate
sexual
health
education
will
empower
parents
to
be
a
resource
to
deliver
sexual
health
information
to
their
children
(Elder
et
al.,
2009).
Thus,
overcoming
the
boundaries
of
communication
concerning
conversation
about
sexual
health
is
critical
to
reduce
sexual
risk
factors
in
Latino
youth.
Both
Latino
parents
and
children
express
the
need
for
information
on
sexual
education,
and
acknowledge
that
parents
are
currently
not
well
equipped
to
provide
it.
When
it
comes
to
talking
about
sex,
both
Latino
parents
and
teens
agree
that
parents
don’t
know
what
to
say,
how
to
say
it
or
when
to
begin
talking
to
their
children
about
sex
(Vexler
et
al.,
2007).
Forty-­‐two
percent
of
teens
aged
12
to
19
strongly
agree
with
the
above
statement,
and
forty-­‐eight
percent
of
the
parents
agree
that
they
don’t
know
how,
when
or
what
to
say
to
their
teens
about
sex
(Vexler
et
al.
2007).
Evidence
shows
that
seventy
percent
of
adolescents
would
like
to
obtain
more
information
about
abstinences
and
birth
control,
and
approximately
three
fourths
of
Latina
girls
and
two
thirds
of
Latino
boys
wish
their
sexual
debut
would
have
occurred
later
than
it
did.
Finally,
over
ninety
percent
of
Latino
teens
believe
they
should
be
encouraged
to
delay
sex
until
they
are
out
of
high
school
(Vexler
et
al.,
2007).
Even
though
evidence-­‐based
interventions
exist
to
improve
parental
communication
between
teens
and
parents,
there
is
a
lack
of
culturally
appropriate

6. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
6
evidence-­‐based
interventions
that
target
Latino
parents.
The
Latino
population
is
an
especially
important
population
to
study
since
it
suffers
from
high
rates
of
teenage
pregnancy
and
STDs.
Specifically,
over
four
in
ten
Latina
teenagers
were
pregnant
at
least
one
time
before
the
age
of
twenty,
and
in
2008,
one
fourth
of
all
Latina
pregnancies
18
to
19
years
of
age
were
to
teens
that
already
had
a
baby
(National
Campaign
to
Prevent
Pregnancy,
2012).
Such
results
can
be
due
to
a
variety
of
sexual
risk
behaviors
that
affect
the
Latino
population.
The
data
shows
that
almost
fifty
percent
of
all
Latino
high
school
students
report
being
sexually
active,
with
around
eighty-­‐six
percent
report
not
using
birth
control
pills
at
last
intercourse
and
almost
half
report
not
using
condoms
at
their
last
sexual
encounter
(National
Campaign
to
Prevent
Pregnancy,
2012).
In
contrast,
only
less
than
forty
percent
of
white
students
reported
not
using
condoms
during
their
last
intercourse.

7. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
7
Proposed
Project
The
proposed
intervention
utilizes
the
socio-­‐cognitive
theory
to
reduce
sexual
risk
behaviors
through
the
improvement
of
parental-­‐adolescent
communication
in
Latino
families.
The
culturally
appropriate
intervention
aims
to
teach
Spanish
speaking
Latino
parents
of
middle
school
students
(ages
11-­‐14)
how
to
effectively
communicate
sexual
education
to
their
teens.
The
intervention
will
consist
of
one
3-­‐hour
session
and
four
follow-­‐up
phone
calls
throughout
the
span
of
twelve
months.
The
session
will
be
led
by
a
Latino
health
educator
that
will
focus
on
effective
communication
and
parental
monitoring
strategies
to
delay
the
onset
of
sexual
intercourse
in
the
young
Latino
adolescent
population.
As
opposed
to
abstinence
only
programs
that
strictly
focus
on
abstinence
until
marriage,
the
focus
of
the
currently
proposed
program
is
to
provide
parents
with
comprehensive
education
about
birth-­‐control
and
safe
sex
for
their
teens,
as
well
as
model
culturally
appropriate
strategies,
such
as
focus
on
how
they
can
use
existing
family
values
such
as
Familismo
and
Respeto
to
talk
to
their
children
and
delay
their
adolescents
onset
of
sexual
activity.
The
proposed
intervention
will
be
implemented
Saturdays
in
South-­‐Texas
middle
schools,
given
the
high
Latino
population
rates
in
this
area.
The
Latino
health
educator
conducting
the
program
will
recruit
parents
and
provide
them
with
flexible
times
when
they
can
attend
the
intervention,
as
well
as
perform
follow-­‐up
calls
post-­‐intervention.
The
first
part
of
the
3-­‐hour
session
will
consist
of
introductions.
In
addition,
the
health
educator
will
focus
on
providing
the
parents
with
information
on
Latino
teenage
pregnancy
and
STD
rates.
All
the
information
provided
by
the
health
educator
will
be
at
the
appropriate
literacy
level
for
the
parents.
The
handout
provided
to
the
parents
about
birth

8. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
8
control
and
protection
will
be
in
Spanish,
concise
and
simple,
so
that
parents
can
use
them
as
future
reference
to
talk
to
their
children.
The
health
educator
will
also
cover
all
the
information
on
the
handouts,
because
some
parents
might
not
be
fully
literate.
Next,
the
second
section
of
the
program
will
focus
on
the
importance
of
parents
taking
to
their
teens
about
protection
and
birth
control
in
a
culturally
appropriate
way.
Cultural
myths
regarding
birth
control
and
protection
will
be
addressed.
For
example,
the
idea
that
parents
focus
only
on
abstinence
in
regards
to
their
daughters
and
don’t
generally
talk
to
their
sons
about
reproductive
health,
referred
in
the
literature
as
Marianismo,
will
be
addressed.
Letting
the
parents
know
that
pregnancy
is
not
the
only
consequence
from
unprotected
sex
and
that
educating
their
sons
will
in
turn
protect
other
people’s
daughters
can
encourage
them
to
reduce
gender
biased
health
education.
Finally,
the
intervention
will
focus
on
how
parents
can
make
a
difference
in
their
children’s
sexual
decision
making
by
increasing
parental
monitoring
and
encouraging
them
to
make
healthy
decisions
about
their
sexual
health.
It
is
important
to
let
the
parents
know
that
their
children
want
to
talk
about
sex
issues
with
them
and
that
research
shows
they
can
influence
when
their
children
decide
to
begin
having
sex.
Topics
in
this
section
will
include
reasons
teens
chose
to
have
sex
and
reasons
teens
choose
not
to
have
sex.
Another
topic
addressed
will
be
how
to
overcome
cultural
barriers
in
talking
to
their
teens
about
sex.
For
example,
it
will
be
important
to
address
values
such
as
machismo
and
marianismo
that
can
contribute
to
high
sexual
risk
behaviors.
One
of
the
components
of
the
intervention
will
help
parents
identify
a
variety
of
opportunities
where
they
can
talk
to
their
children
about
sex.
For
example,
using
Tele-­‐novelas
to
spark
conversation
around
safe
sex
can
be
an
effective
education
tool.
Moreover,
the
parents
will
be
presented
with

9. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
9
short
clips
that
will
include
scenarios
that
parents
might
face
with
their
teens,
and
as
a
group
parents
will
be
guided
by
the
Health
educator
to
determine
what
to
say
and
how
to
say
it.
In
addition,
throughout
the
3-­‐hour
program,
parents
will
be
presented
with
clips
that
provide
tele-­‐novela
style
scenarios
where
Hispanic
parents
face
challenges
in
talking
to
their
children
about
sex.
The
health
educator
will
guide
the
parents
on
how
to
adequately
tackle
such
situations,
in
order
to
increase
their
confidence
in
talking
to
their
children
about
sex.
Finally,
parents
will
be
provided
with
a
number
they
can
call
if
they
have
any
further
questions
or
encounter
future
challenges
when
talking
to
their
children
about
sex.
In
addition,
they
will
be
informed
that
the
health
educator
will
be
calling
them
to
follow-­‐up
every
three
months,
within
the
span
of
the
next
twelve
months,
in
order
to
answer
any
question
that
might
arise.
Population
and
Aims
of
Project
Spanish
speaking
Latino
parents
of
middle
school
students
ages
11
to14
in
South-­‐
Texas
are
the
target
population
for
the
proposed
intervention.
The
Spanish
speaking
Latino
parent
population
was
chosen
because
there
is
a
lack
of
interventions
that
provide
culturally
appropriate
sexual
education
information
for
parents
with
Latino
backgrounds.
The
intervention
will
be
implemented
during
one
three
hour
session
on
a
Saturday
and
will
be
followed
by
booster
calls.
South-­‐Texas
Middle
schools
were
chosen
because
the
population
in
this
area
is
almost
ninety
percent
Hispanic
(Sharyland,
2010).
A
Latino
health
educator
will
briefly
describe
the
program
and
invite
the
parents
to
participate.
Parents
of
Latino
students
ages
11
to
14
were
chosen
because
the
programs’
main
goal
is
to

10. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
10
delay
the
onset
of
sexual
activity,
and
the
only
way
we
can
accomplish
this
goal
is
by
targeting
the
young
teen
population
that
has
not
yet
initiated
sexual
activity.
Furthermore,
parents
equipped
with
valuable
information
can
provide
the
information
the
teen
needs
when
it’s
developmentally
appropriate.
For
example,
once
the
parent
knows
or
suspects
the
teen
is
sexually
active,
he
or
she
can
talk
to
them
more
thoroughly
about
safe
sex
practices
(O’Donnel
et
al.,
2005).
The
purpose
of
this
intervention
is
to
increase
parental
knowledge
of
safe
sex
practices,
to
address
cultural
barriers
that
inhibit
parents
from
talking
to
their
children
about
sex,
to
focus
on
identifying
teachable
moments
where
the
parents
can
initiate
conversations
about
sex
and
to
emphasize
the
importance
of
parental
monitoring
to
decrease
risky
sex
behaviors.
Throughout
the
3-­‐hour
program,
parents
will
be
presented
with
clips
that
provide
tele-­‐novela
style
scenarios
where
Hispanic
parents
face
challenges
in
talking
to
their
children
about
sex.
The
health
educator
will
guide
the
parents
on
how
to
adequately
tackle
such
situations,
in
order
to
increase
their
confidence
in
talking
to
their
children
about
sex.
Finally,
follow-­‐up
calls
will
be
used
to
provide
quick
booster
sessions
where
the
health
educator
can
determine
if
the
parent
has
talked
to
their
child
about
sex,
and
answer
any
questions
the
parents
might
have
about
educating
their
teens
about
sex.
Rational
For
Project
Approach
There
is
evidence
that
demonstrates
that
improving
parental
communication
and
parental
monitoring
will
decrease
the
sexual
risk
behaviors
and
delay
onset
of
sexual
activity
in
middle
school
children
(Guilamo
et
al.,
2011).
School
based
interventions
like
MAD
(Making
a
Difference!)
and
FTT
(Families
Talking
Together)
which
target
parental

11. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
11
communication
in
a
school
based
setting,
demonstrate
that
intervening
before
a
teen
begins
having
sex
can
delay
the
onset
of
sex
and
increase
the
teens
safe
sex
practices
in
the
future
(O’Donnel
et
al.,
2011).
The
intervention
is
modeled
after
the
social
learning
theory
and
the
social
cognitive
theory,
which
posit
that
learning
occurs
through
observations,
personal
experiences,
and
interactions
with
the
individual’s
immediate
environment.
The
actions
of
the
individual
are
determined
through
the
interpretation
and
response
to
their
surrounding
environment,
which
will
determine
future
action.
The
individual
internalizes
“moral
codes”
through
a
process
of
personal
evaluation
and
reinforcement
that
comes
from
himself
as
well
as
from
the
environment
(Blake
et
al.,
2001).
Through
their
participation
in
the
intervention,
parents
will
become
conduits
of
behavior
change
by
internalizing
the
behaviors
they
are
taught
and
integrating
them
into
their
values
and
beliefs,
which
could
in
turn,
influence
increased
safe
sexual
practices
of
their
children.
Moreover,
research
shows
that
a
thirty
minute
parental
intervention
implemented
in
a
health
care
setting
to
parents
while
their
children
had
a
physical
examination,
significantly
reduced
sexual
risk
behaviors
of
the
adolescent
compared
to
those
in
the
“standard
of
care”
control
group
(Guilamo-­‐Ramos
et
al.,
2011).
In
addition,
many
parent-­‐
based
interventions
are
time
consuming
and
demand
unrealistic
amounts
of
time
and
commitment
from
parents
for
their
successful
implementation
(Guilamo
et,
al.
2011).
Given
this
data,
it
is
important
to
decrease
the
rates
of
attrition
by
conducting
a
one-­‐time
only
intervention
followed
by
booster
calls
which
have
been
proven
to
extend
the
life
of
the
intervention
(Perri
et
al.,
1993).
Brief
contacts
with
the
Health
educator
every
three
months
after
the
intervention
will
provide
parents
with
the
motivation
needed
for
long-­‐

12. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
12
term
behavioral
change
and
establish
a
relationship
between
the
health
educator
and
the
families.
Studies
have
shown
a
decrease
in
protective
behavior,
in
this
case
parental
communication,
after
about
3
months
following
treatment
(Home
and
Glaser
1993).
Thus,
we
decided
to
include
booster
sessions
every
three
months
for
a
one
year
post-­‐
intervention.
Many
interventions
targeted
to
Latinos
focus
on
“window-­‐dressing”
approaches
in
which
the
language
may
be
changed
and
the
materials
translated
but
cultural
values
are
not
integrated
into
the
essence
of
the
intervention.
Research
suggests
that
designing
culturally
appropriate
interventions
means
to
base
the
intervention
on
the
cultural
values
of
the
specific
population
and
to
ensure
that
the
program
reflects
the
“attitudes,
expectancies,
and
norms
of
the
target
population
regarding
a
particular
behavior”
which
in
this
case
concerns
sexual
health
education
for
Latino
parents.
Socio-­‐cultural
strategies
should
align
themselves
with
cultural
values
to
provide
meaningful
health
information
to
the
target
population
(Marin
(1993)
&
Kreuter
et
al.,
2002).
Thus,
the
intervention
will
focus
on
Latino
values
such
as
familismo
and
respeto
as
well
as
provide
culturally
appropriate
examples
such
as
using
telenovela
style
clips
where
parents
can
model
their
parenting
skills
after,
and
can
more
easily
relate
to
the
scenarios.
Telenovela
viewing
in
Latin
American
culture
forms
a
central
part
of
everyday
life
and
influences
the
formation
and
articulation
of
social
identity.
The
massive
consumption
of
telenovelas
conveys
feelings
and
identities
and
gives
motivation
towards
discussions
within
Latino
social
network
relations
(Tufte,
2003).
Through
the
use
of
telenovela
style
clips,
parents
will
feel
like
the
intervention
is
aligned
with
their
daily
traditions,
activities
and
social
interactions.
In
addition,
the
health
educator
will
be
Latino
and
Spanish
speaking
in
order
to
facilitate
a

13. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
13
relationship
with
the
parents
that
will
influence
their
continued
communication
throughout
the
year.
The
purpose
of
the
intervention
is
to
increase
parental
knowledge
of
safe
sex
practices,
to
address
cultural
barriers
that
inhibit
parents
from
talking
to
their
children
about
sex,
to
focus
on
identifying
teachable
moments
where
the
parents
can
initiate
conversations
about
sex
and
to
emphasize
the
importance
of
parental
monitoring
to
decrease
risky
sex
behaviors.
The
above
behaviors
will
be
measured
through
a
pre-­‐
session
questionnaire,
one
week
post
session
questionnaire
and
questionnaires
at
3
months
and
12
months
follow-­‐up.
Using
a
four
point
Likert
scale,
parent-­‐Adolescent
communication
will
be
measured
using
15
items
in
which
the
adolescent
will
say
whether
they
had
talked
to
their
parents
about
sex.
An
example
of
an
item
would
be,
“how
if
I
had
sexual
intercourse
at
this
time
in
my
life,
I
might
get
an
STD.”
Maternal
monitoring
and
supervision
will
be
assessed
through
asking
questions
about
the
frequency
of
their
unsupervised
outing,
where
there
could
be
increased
opportunities
to
engage
in
risky
sexual
behaviors.
Perceived
maternal
expertise
on
the
subject
of
sexual
education
will
be
assessed
by
asking
the
adolescent
questions
on
a
five
point
agreement
scale.
An
example
of
a
question
would
be
“I
trust
my
mother
when
we
talk
about
sex.”
Sexual
behavior
will
be
assessed
by
asking
teens
about
the
frequency
of
their
sexual
encounters
on
five-­‐point
scale
(Guilamo
et.
al.,
2011).
Through
the
establishment
of
a
trusting
relationship
between
the
parent
and
the
health
educator
we
hope
to
reduce
the
rates
of
attrition
during
the
follow
up
times
for
the
proposed
intervention.

14. A
CULTURALLY
APPROPRIATE
SEXUAL
EDUCATION
INTERVENTION
14
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SEXUAL
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