HISTORIA

9.3.1 Introduction

This dissertation, using the NSFG--a nationally representative survey, is able to make comparisons in sexual health communication and outcomes for individuals in different groups. I am able to demonstrate on a large scale that raced and gendered patterns in sexual health

education from parents and formal education exist. I am also able to show statistically

significant associations between social location, sexual education, and protective behaviors for young Americans today. However, there are particular challenges that face research on sexual education that utilizes a nationally representative survey.

First, survey questions lack the detail that other methods, such as interviews, can provide. Therefore, I can determine that a topic was mentioned, but I cannot get detail about the tone of the message. I am also unable to determine which source—which parent or which formal education setting—provided the information. Secondly, I am also unable to determine the temporal order of the communication and behavior pattern. I do not know if the young adult received the information before or after sexual activity took place. Thirdly, the NSFG survey

focuses narrowly on vaginal intercourse. Therefore, I am unable to investigate risk involving other types of sex. Finally, I cannot test the influence of other agents of socialization using the NSFG survey. Future research would benefit from qualitative methods, such as interviews, that could get more detail about the nature and timing of sexual health information and its effect on a wide range of sexual behaviors.

9.3.2 Limitations

One possible limitation of the study is the inclusion of religion in the model. One critique of this study is that religion could potentially be mediators instead of control variables.

Therefore, I removed religious attendance, religiosity, and religious denomination to see if the process of social location, sexual education, and protective sexual health behaviors are

independent of religion. Religion appears to have no significant effect on the outcomes of the models for all protective behaviors. The results for each chapter did not change despite the omission of the religious control variables. Religion has no effect on the relationships between race, gender, and protective health behaviors.

The nature of the communication between parents, formal sexual education, and young adults is unknown. The questions in the National Survey of Family Growth only ask if a certain topic was mentioned by parents or formal sexual education programs. However, I have no way to know what was discussed further and what information was given to the young adults. For

example, with condom use, is the nature of the communication positive or negative? Are young adults encouraged to use condoms? Or are they told not to carry condoms because it would encourage them to be promiscuous? If I am able to know the context of the message, I could have investigated further if the messages are approving or disapproving of certain topics and how

approving or disapproving messages can affect a young adult engaging in certain protective behaviors.

In addition to not being able to understand the context of the message, I cannot ascertain the frequency with which young adults were educated about sex by formal programs or parents. The question only asks if the topic is ever mentioned, but no question exists in the NSFG that asks how many times a certain topic is mentioned. If consistent communication is key in encouraging protective sexual health behaviors, then this study could have been improved by incorporating not only the type of message young adults received but how frequently or consistently they receive it to examine if consistent communication is more impactful on protective sexual health behaviors.

Additionally, the NSFG only asks if a young adult discussed a topic with a parent or received education in a formal sexual education program. For parents, I cannot tell whether the mother, father, or both parents of the young adult discussed sex with their child. Previous studies have found links between the gender of the parent, the child, and engaging in protective sexual health behaviors (Levin and Robertson 2002; Ellis et al. 2003; Aronowitz et al. 2007; Katz and Van der Kloet 2010; Wright, Randall, and Arroyo 2013). The study could have been improved if I could ascertain whether the mother, father, or both parents discussed sex with his or her child.

Additionally, I cannot determine where young adults received formal sexual education. The question in the NSFG asks if the respondent received formal sexual education that could include schools, community centers, and churches. The sexual education one may receive from a public school may be quite different than the education they would receive from a church-based sexual education program. If I am able to understand where young adults received their formal

sexual education, I can determine the effectiveness of various formal sexual education programs or focus solely on formal sexual education taught in schools.

The current study cannot determine whether communication about sexual health from parents and formal sexual education programs took place before or after the young adult became sexually active or was nearing sexual activity. Since I cannot determine the timeline of sexual health communication, it may lead to assumptions that sex education—and parental

communication in particular—contribute to a decrease in protective sexual health behaviors. Therefore, the study could have been greatly improved if the respondents were asked in the NSFG if they had received sexual education from parents and formal sources before they were sexually active. If I can determine temporally when communication and sexual activity took place, then I would be better able to determine if sexual education before sexual debut contributes to an increase or decrease in protective sexual health behaviors.

Finally, the study is heteronormative and does not examine other sexual acts besides vaginal intercourse. I examined how social location, parental communication, and formal sexual health education contributed to protective sexual health behaviors during vaginal intercourse that took place between two people of the opposite sex. By only examining heterosexual vaginal intercourse, LGBTQ+ youth are excluded from the study. Furthermore, by limiting the analysis to heterosexual vaginal intercourse, I am not examining other sexual behaviors such as oral sex and anal sex which may also transmit HIV and other STIs. Therefore, I am not able to look at other sexual behaviors that may leave young adults at risk for HIV and STIs in the present study.