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Despite declining rates, unintended adolescent pregnancy remains a considerable public health challenge in the United States (Hamilton, Martin, & Osterman, 2015). Unintended pregnancy leads to a host of negative outcomes not only for adolescents, but also for their children who are more likely to get trapped in a cycle of poverty that is difficult to break (Rew & Wong, 2006). Factors such as poverty are difficult to address; nonetheless, sexual reproductive health (SRH) knowledge and parent-adolescent communication (PAC) have been identified as important tools for prevention, and potentially modifiable (Swenson et al., 2009; 2010). The goal of the current study was to examine change in SRH knowledge and PAC. Pretest, posttest, and three-month follow-up data were collected from 176 adolescents (M = 15.70 years, SD = 1.93) who participated in a comprehensive sexual health education program conducted in a Midwestern state with conservative adolescent SRH policies. Study one examined change in SRH knowledge over time, and assessed whether sexual experience, religiosity, cultural awareness, immigration status, and gender moderated change in SRH knowledge. Multi-level modeling analyses showed that SRH knowledge increased; however, the rate decreased over time. Immigrants had significantly lower initial SRH knowledge compared to American-born participants; however, neither group experienced change over time. Adolescents with high cultural awareness had lower initial SRH knowledge; however, their SRH knowledge increased over time whereas it declined for participants with low cultural awareness. Finally, girls had lower initial SRH knowledge; however, they experienced greater growth compared to boys over time. In the second study, we examined the relation between PAC and sexual experience, religiosity, cultural awareness, immigration status, and gender. Our results showed that only immigration status was associated with PAC. At pretest, American-born participants had higher PAC; however, there was no change over time. Discussion focusses on the implications of these findings for sexually transmitted infections and pregnancy prevention among at-risk adolescents living in states that are socially and politically conservative towards adolescent SRH.