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Health Communication
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/hhth20
How Family Sex Talks Can Increase Daughters’
Intentions to Engage in Sexual Health Protective
Behavior: Mediating Roles of Parents’ Direct and
Indirect Sexual Communication
Qiwei Luna Wu & Elizabeth Pask
To cite this article: Qiwei Luna Wu & Elizabeth Pask (05 Dec 2023): How Family Sex Talks Can
Increase Daughters’ Intentions to Engage in Sexual Health Protective Behavior: Mediating
Roles of Parents’ Direct and Indirect Sexual Communication, Health Communication, DOI:
10.1080/10410236.2023.2291268
To link to this article: https://doi.org/10.1080/10410236.2023.2291268
Published online: 05 Dec 2023.
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How Family Sex Talks Can Increase Daughters’ Intentions to Engage in Sexual Health
Protective Behavior: Mediating Roles of Parents’ Direct and Indirect Sexual
Communication
Qiwei Luna Wu and Elizabeth Pask
School of Communication, Levin College of Public Affairs and Education, Cleveland State University
ABSTRACT
The family environment is essential but underused for promoting sexual and reproductive health
protective behaviors (SHPB). However, previous literature had no consistent ndings regarding how
families can eciently provide sex education and what aspects of family communication may facilitate
SHPB. Based on family communication patterns theory (FCPT) and new research that segments family
conformity orientation into four sub-dimensions (i.e., respecting parental authority, experiencing par-
ental control, adopting parents’ values, and questioning parents’ beliefs), we explored the roles that
family communication patterns (FCP) and parents’ (direct and indirect) sexual communication play in
inuencing adult daughters’ intentions to engage in SHPB. Using survey data from 234 female partici-
pants, path analysis suggested that daughters’ SHPB intentions were associated with more direct and
indirect sexual communication, higher conversation orientation, higher parental control, and less adop-
tion of parental values. Also, parents’ direct sexual communication mediated the impact of conversation
orientation on SHPB intentions. Additionally, parents’ indirect sexual communication mediated the path
from parental value adoption to SHPB intentions, mitigating the negative direct impact of parental value
adoption. Theoretical and practical implications are discussed.
One in five people in the United States may have a sexually
transmitted infection (STI) (Centers for Disease Control and
Prevention, 2021). Among women, STIs can cause human
papillomavirus (HPV) infection, resulting in more than
311,000 cervical cancer deaths annually (World Health
Organization, n.d.). Compared with men, women are dispro-
portionately affected by STIs, for reasons ranging from female
biology to social/structural barriers subjecting women to lim-
ited prevention services and financial security fundamental to
sexual health (Van Gerwen et al., 2022). Only 38 states and the
District of Columbia mandate some type of sexual education
and/or HIV prevention program in schools (Guttmacher
Institute, 2016) and school sex education has not yet succeeded
to reduce incidences of STIs and unintended pregnancies
(Shalihin et al., 2023). The lack of comprehensive sex educa-
tion in schools often results in sexual and reproductive health
knowledge gaps for young people who must utilize other
information sources (e.g., TV, social media, peers, parents) to
gain sexual knowledge (Fisher et al., 2023; White et al., 2023).
Compared to media and peers, parents were the least com-
monly utilized sexual information source reported by emer-
ging adults (White et al., 2023). Nevertheless, effective parent-
child communication about sex (i.e., regarding sexual atti-
tudes, values, and risk-related beliefs; thereafter, “sexual com-
munication”) can promote positive health outcomes for
children (Bonafide et al., 2020; Widman et al., 2016). For
example, a meta-analysis showed a significant association of
improved condom use in parent-based interventions
(Widman et al., 2019). Research also documented the connec-
tion between families’ sexual communication (about sexuality,
relationships, morals, and pregnancy) and reduced risky beha-
viors by sexually active teenagers (Heisler, 2005).
Sex may be taboo for many families due to normative
beliefs viewing sex as inappropriate (Grossman, Pearce
et al., 2021), and little is known regarding how the family
communication environment and parental strategies to talk
about sex can affect children’s sexual and reproductive
health protective behaviors (SHPB). One the one hand,
the literature showed negative and sometimes non-
significant associations between family conformity orienta-
tion and families’ sexual communication to reduce STI
risks (Holman & Kellas, 2015; Horan et al., 2018). On the
other hand, previous research on the frequency of families’
sexual communication highlighted potential influences of
how such communication was conducted. For instance,
while parents’ sexual communication is often infrequent
(Padilla-Walker et al., 2020), their direct (explicit) and
indirect (e.g., “be careful”) sexual communication may
expose children to sexually-related topics (e.g., STD and
pregnancy prevention, consent) (Heisler, 2005). However,
the relationship between such exposure and children’s
SHPB intentions is understudied. Hence, based on family
communication patterns theory (Ritchie & Fitzpatrick,
1990), this study examines the influence of the family
communication environment and directness of parent
communication about sex on women’s SHPB intentions.
CONTACT Qiwei Luna Wu q.wu59@csuohio.edu School of Communication, Levin College of Public Affairs and Education, Cleveland State University, 2121
Euclid Ave, MU 233, Cleveland, OH 44115
HEALTH COMMUNICATION
https://doi.org/10.1080/10410236.2023.2291268
© 2023 Taylor & Francis Group, LLC
Our findings may inform future interventions by identify-
ing essential communication factors related to SHPB
intentions.
Family communication patterns theory
Family communication patterns theory (FCPT) argues that
families may create shared beliefs and values through com-
munication (Ritchie & Fitzpatrick, 1990). According to
FCPT, two communication dimensions, conversation and
conformity orientations, help create unique family environ-
ments that shape members’ attitudes and behaviors within
and outside the family. Conversation orientation is the open-
ness of a family’s interpersonal conversations (Koerner &
Fitzpatrick, 2002). Families with higher levels of conversa-
tion orientation tend to interact frequently, discuss many
topics with few limitations, encourage personal disclosures
of thoughts and experiences, and engage in shared decision-
making (Koerner & Fitzpatrick, 2002). Conformity orienta-
tion refers to a family’s tendency to act uniformly (Koerner
& Fitzpatrick, 2002). Families with higher levels of confor-
mity orientation value homogeneity of beliefs and may
expect children to follow parental beliefs (Koerner &
Fitzpatrick, 2002).
Scholars have extensively applied FCPT to understand the
impact of the family communication environment on health
outcomes. For example, conversation orientation predicted
more disclosure of health issues to a parent (Hays et al.,
2017) and stronger perceived social support in families
(Bevan et al., 2021) potentially due to its ability to foster an
open environment for sensitive and emotional topics.
Conformity orientation predicted various psycho-behavioral
outcomes (e.g., conflict behavior, self-disclosure) (Schrodt
et al., 2008), but such predictions were often negative and
may be moderated by conversation orientation (Horstman
et al., 2018). Researchers argued that this might be due to
a disconnect between conceptualization and operationaliza-
tion of conformity orientation (Hesse et al., 2017; Horstman
et al., 2018).
To bridge the gap, some scholars proposed a “cold” (coer-
cive control) and a “warm” (promotion of unity and equality)
dimension within conformity orientation (Hesse et al., 2017).
Horstman et al. (2018) reconceptualized conformity orienta-
tion by identifying four conformity orientation sub-
dimensions that may further account for the complexity of
the orientation. They include: respecting parental authority
(i.e., expectations for child discipline and obedience), experi-
encing parental control (i.e., expectations for parental decision
making for their children), adopting parents’ values (i.e., expec-
tations for shared values among family members), and ques-
tioning parents’ beliefs (i.e., expectations for unity and
harmony within a family). Horstman et al. (2018) argued
that these sub-dimensions will allow for a more nuanced
understanding of family dynamics and impacts of conformity
orientation on individual and family outcomes. The current
study operationalized the work by Horstman et al. (2018) to
explore how different facets of conformity orientation relate to
parent communication about sex and women’s SHPB
intentions.
FCP and women’s SHPB intentions
How the family communication environment (in terms of con-
versation and conformity orientations) relates to children’s SHPB
(intentions) is not well established. Holman and Kellas (2015)
reported significant bivariate relationships between conversation
orientation, conformity orientation and sexual risk-taking beha-
vior, but those relationships were not significant when examined
in models with multiple predictors. Nevertheless, previous
research showed that some communication factors potentially
mediated the impact of FCP on children’s outcomes. For example,
Hurst et al. (2022) did not find a relationship between FCP and
condom use intentions, though FCP were related to communica-
tion-related variables (e.g., parent-child sex communication, part-
ner communication intentions). Dorrance Hall and Scharp (2018)
reported that the relationship between conversation orientation
and the perceived impact of college transition on students’ lives
was mediated by students’ reports of their communication appre-
hension. Similarly, Hesse et al. (2016) demonstrated that alexithy-
mia fully mediated the relationships between FCP and
communicative responses to jealousy. As such, we argue that the
relationship between FCP and females’ SHPB intentions may be
mediated by sex-related communication in the family. Of interest
in our study is the directness of parent communication about sex.
Directness of parent communication about sex and FCP
Parent communication about sex can influence children’s sex-
ual attitudes, behaviors, and health outcomes. Parent sexual
communication is often infrequent, may take the form of
a one-time “sex talk” (Padilla-Walker et al., 2020), focus pri-
marily on sexual risk topics (e.g., safer sex, abstinence, STIs),
and ignore sex-positive topics (e.g., sexual satisfaction, sexual
desire) (Evans et al., 2020; Goldfarb et al., 2018). Findings are
mixed regarding the role of parent communication frequency
in their children’s sexual outcomes. Some scholars reported
that more frequent parent sexual communication was related
to increased safer sex practices (Askelson et al., 2012; Bonafide
et al., 2020; Hadley et al., 2009; Wright, 2009), whereas other
scholars found that parent communication frequency only
served health protective functions (e.g., condom use, promote
partner sexual communication) for teenagers when their par-
ents were open, skilled, and comfortable discussing sexual
topics (Whitaker et al., 1999). The impact of communication
frequency appears dependent on the type and quality of the
communication interaction. Consequently, the current study
focuses on how parents talk about sex and how those strategies
relate to both FCP and women’s SHPB intentions.
Parent-child discussions about sex vary in terms of parent
communication style. While some literature documented how
parents’ scare tactics (Astle et al., 2022), commands (Goldfarb
et al., 2018), and comprehensiveness (Goldfarb et al., 2018) of
their sex talks influenced their children’s approaches to sexual
communication/behavior, this study focuses on the directness
of parental communication. Grossman et al. (2021) argued
that direct communication about sex occurs when sexual
topics are specifically addressed in conversation (e.g., discus-
sion about how to protect against STIs), whereas indirect
communication about sex is to rely on more general (instead
2Q. L. WU AND E. PASK
of explicit/specific) ways to convey sexual values (e.g., talking
about a sexual issue in the presence of the child, but not to the
child; making comments about sexual activity in a TV show).
Measures of parent sexual communication typically focus only
on direct communication (Grossman, DeSouza et al., 2021).
Indirect sexual communication is important to consider parti-
cularly in cultures where sex is a sensitive topic (Grossman,
Pearce et al., 2021). For example, Wang (2016) reported that
parents of Chinese adolescents used both direct communica-
tion (e.g., prohibitive messages) and indirect communication
styles (e.g., open judgment of peer sexual behavior) to com-
municate about sex (values) with their children. Both parents
and adolescents tended to avoid direct communication about
sexuality often due to embarrassment and adolescents’ concern
that such discussions would damage their image as “a good
kid” (Wang, 2016, p. 239).
Family communication environment cultivates the atti-
tudes and beliefs among family members (Horstman et al.,
2018) and may shape communication interactions (e.g., direct-
ness of parental sexual communication). Preliminary evidence
connecting conversation orientation to more direct parent
communication include the literature showing that conversa-
tion orientation predicted higher parent sexual communica-
tion frequency (Holman & Kellas, 2015; Horan et al., 2018).
The measures of such frequency focused on talk about sexual
topics that reflect Grossman et al. (2022) definition of direct
communication. Experimental research on opioid misuse also
found that direct messages about opioid risks may be more
effective for respondents with high (compared with low)
family conversation orientation (Kemp et al., 2022). For indir-
ect communication, scant research showed connections
between high conversation orientation and adolescents’ use
of indirect problem resolutions during holidays (Singh &
Nayak, 2016).
Regarding conformity orientation, research suggested that it
may decrease (Holman & Kellas, 2015) or have no impact on
direct parent communication about sex (Horan et al., 2018), but
these studies considered conformity as unidimensional.
Nevertheless, research on parenting styles (that published before
the proposal of the conformity orientation subdimensions) sug-
gested no consistent relationships between the later-proposed
conformity orientation subdimensions and directness of parents’
sexual communication. For families valuing parental authorities,
some would avoid direct communication about sex (Chung et al.,
2005), while others may deliver explicit warnings against premar-
ital sex (Wamoyi et al., 2010). Parental control may also come in
different styles, such as ambiguously suggesting a no-dating rule
(indirect) (Wang, 2016) and explicitly discussing sex while
inspecting children’s private parts (direct) (Wamoyi et al., 2010).
Parents may transmit values via direct discussion around morality
(virtues of virginity) (Wang, 2016) and indirect facilitation by
school-based sex educational programs (Chung et al., 2005).
Potentially due to the sensitivity of sex-related topics in a family
context, no research to our knowledge has documented how
children’s experience with questioning parents’ beliefs is related
to the directness of parents’ communication. Thus, we propose the
following:
H1: Higher levels of conversation orientation are related to
(a) more direct parent communication about sex and (b) more
indirect parent communication about sex.
RQ2: Are the four dimensions of conformity orientation
(i.e., respecting parental authority, experiencing parental con-
trol, adopting parents’ values and beliefs, questioning parents’
beliefs and authority) related to (a) direct parent communica-
tion about sex and (b) indirect parent communication about
sex?
Abundant research suggested that both open/direct com-
munication and metaphoric/indirect communication were
associated with improved health outcomes. For example,
open communication in the family may help address chil-
dren’s mental health needs by reducing their likelihood of
forgoing care (Wu & Brannon, 2023). Explicit and infor-
mative communication of clinicians may improve treat-
ment outcomes by enhancing patients’ trust and
adherence (Street et al., 2009). Likewise, metaphors and
analogies showed effectiveness in improving patients’ satis-
faction with their clinicians’ communication (Casarett
et al., 2010), potentially leading to greater intentions to
do sexual health screenings (Spina et al., 2018). The
exploration of the impact of direct and indirect sexual
communication in the family is limited, but Gibson et al.
(2020) reported that the openness of maternal sexual com-
munication predicted young adult daughters’ health screen-
ing efficacy. Therefore, we hypothesize:
H3: Direct parent communication is related to women’s
increased intentions to engage in SHPB.
H4: Indirect parent communication is related to women’s
increased intention to engage in SHPB.
The family communication environment promotes (or pre-
vents) the development of communication behaviors (e.g.,
directness of parent communication about sex) that in turn,
relate to children’s SHPB intentions. However, given limited
evidence to effectively predict a mediation model in this con-
text, especially in relation to the new multidimensional oper-
ationalization of conformity, we ask research questions, rather
than pose hypotheses.
RQ5: Is the relationship between women’s SHPB intentions
and conversation orientation mediated by (a) direct parent
communication about sex or (b) indirect parent communica-
tion about sex?
RQ6: Is the relationship between women’s SHPB intentions
and the four dimensions of conformity orientation (i.e.,
respecting parental authority, experiencing parental control,
adopting parents’ values and beliefs, questioning parents’
beliefs and authority) mediated by (a) direct parent commu-
nication about sex or (b) indirect parent communication about
sex?
HEALTH COMMUNICATION 3
Method
Procedures and participants
Between January 2022 and February 2023, students from
undergraduate courses at a Midwestern University were
recruited to participate and/or to recruit qualified participants
from their social network (i.e., 18 years of age and older) to
complete a questionnaire on communication and health beha-
viors. The study was approved by the sponsoring University’s
Institutional Review Board (IRB-FY2022-111). Three hundred
and thirty-three individuals participated in the study. Since the
focus of this study was on female sexual health, only the data
from the 234 female participants are reported herein.
Measures
Family communication patterns (FCP)
Conversation orientation was measured using the 15-item con-
versation orientation subscale of the Revised Family
Communication Scale (Ritchie & Fitzpatrick, 1990). Sample
items include “My parents often say something like every
member of the family should have some say in family deci-
sions” and “In our family we often talk about our feelings and
emotions.” Items were averaged to represent conversation
orientation (M = 3.90, SD = 1.15, α = .95).
Conformity orientation was measured using the 24-item,
multidimensional Expanded Conformity Orientation Scale
(ECOS) (Horstman et al., 2018). Nine items measuring respect-
ing parental authority (e.g., “My parents have clear expecta-
tions about how a child is supposed to behave”) were averaged
to create a composite (M = 4.56, SD = .79, α = .84). Six items
measuring experiencing parental control (e.g., My parents feel
it is important to be the boss”) were averaged to create
a composite (M = 3.78, SD = 1.07, α = .80). Five items measur-
ing adopting parents’ values (e.g., “I feel pressure to adopt my
parents’ beliefs”) were averaged to create a composite (M =
3.62, SD = 1.09, α = .84). Four items measuring questioning
parents’ beliefs (e.g., My parents encourage open disagreement)
were averaged to create a composite (M = 3.78, SD = 1.07, α
= .82). Participants recorded their responses to all conversa-
tion orientation and conformity orientation items on a six-
point scale (1 = strongly disagree to 6 = strongly agree).
Negatively keyed items were recoded so that higher values
indicated greater endorsement of the item.
Parent communication about sex
Parent(s) communication about sex was measured on a six-
point scale (1 = never to 6 = always) using Grossman et al.
(2021) direct and indirect sexual communication subscales.
Participants were directed to think about their parent(s) com-
munication about sex while growing up. Direct communication
about sex was measured using nine items (e.g., “How often did
your parent(s) talk about protecting yourself from STDs?” and
“How often did your parent(s) talk about that sex is ok if both
people agree to it?”) that were averaged to create a composite
(M = 2.50, SD = 1.17, α = .93). Indirect communication was
measured using three items (e.g., “How often did your parent-
(s) make comments to you about other people’s sexual beha-
vior?” and “How often did your parent(s) make comments to
you about the sexual behavior of movie and TV characters?”)
that were averaged to create a composite. One item (“How
often did your parent(s) talk to other people about sexual
issues when you were in the room?”) was dropped from the
scale to improve the reliability from α = .69 to α = .73 (M =
2.35, SD = 1.15).
Outcome variable: SHPB intentions
Women’s SHPB intentions were measured on a six-point scale
(1 = extremely unlikely to 6 = extremely likely) with nine items
modeled after the sexual and reproductive healthcare subscale
of the Sexual Health Practices Self-Efficacy Scale (Koch et al.,
2013). All items started with “How likely are you to” and
followed with the following behaviors: (1) “make an appoint-
ment to talk with a healthcare provider if you experience
a sexual health issue”, (2) “perform breast self-exams”, (3)
“talk with a healthcare provider about a sexual functioning
issue (e.g., a lack of interest in or desire for sex, inability to
become aroused, inability to orgasm, and/or pain with inter-
course, etc.”), (4) “get tested for an STI”, (5) “get an HIV test”,
(6) “talk with a healthcare provider about a sexual issue like an
STI”, (7) “talk with a healthcare provider about pregnancy
prevention”, (8) “visit a healthcare provider for a pap smear
or pelvic exam,” and (9) “visit a healthcare provider to have
a mammogram screening if recommended.” Items were aver-
aged to create a composite (M = 4.12, SD = 1.16, α = .90).
Demographic variables
We surveyed participants’ age in years, race (White/Black/
Asian/Native Hawaiian or Alaskan Native/Other), relationship
status (single/dating, but not in a committed relationship/dat-
ing, in a committed relationship/engaged/married/other), sexual
identity (asexual/bisexual/gay/lesbian/pansexual/questioning/
straight/prefer not to say/other), and vaginal and/or anal sexual
intercourse history (1 = yes/0 = no). Since Pearson correlation
and ANOVA tests suggested that only race and sexual inter-
course history were meaningfully related to the outcome vari-
able, they were included in the analysis as covariates (Cohen
et al., 2002). For interpretation and simplicity of the analysis,
race was dichotomized (1 = White/0 = non-White).
Analysis
Confirmatory factor analysis
We conducted confirmatory factor analysis (CFA) with FCP
and parental sexual communication dimensions in STATA
17.0. Considering the model size, we parceled (i.e., averaged)
the items of the latent factors that had more than two indica-
tors (Little et al., 2002). These factors included conversation
orientation (5 parcels), parental authority (3 parcels), parental
control (2 parcels), parental values (2 parcels), and questioning
parental beliefs (2 parcels). Items were randomly assigned to
the parcels within each factor. The initial CFA model con-
tained a second-order latent factor (conformity orientation)
with the first-order factors being the four sub-dimensions of
it. Since the initial model did not converge, another CFA
model with only first-order latent factors was tested. The
modeling employed maximum likelihood estimation. Model
fit was assessed following Kline’s (2015) recommendations
4Q. L. WU AND E. PASK
(i.e., a preferably non-significant Chi-Square test, CFI > .90,
RMSEA < .08, and SRMR < .08). Standardized path coefficients
were used for reporting.
The CFA model generated a good model fit (χ
2
(128) =
191.35, p < .01, RMSEA = .049, CFI = .98, SRMR = .063), with
significant factor loadings on conversation (λ ≥ .77), parental
authority (λ ≥ .74), parental value (λ ≥ .84), questioning par-
ental beliefs (λ ≥ .77), and direct (λ ≥ .84) and indirect parental
communication about sex (λ ≥ .71).
Path analysis
In the path analysis, exogenous variables included the five FCP
dimensions (four conformity dimensions and conversation orien-
tation). Endogenous variables were parents’ direct and indirect
communication about sex, and SHPB intentions. The intentions
were regressed on direct and indirect communication about sex,
and direct and indirect communication was regressed on the FCP
dimensions. A non-directional path accounted for the theoretical
connection between direct and indirect communication.
Results
Descriptive and bivariate analysis
Participants average age was 24.30 (SD = 7.49). Most partici-
pants reported their racial/ethnic background as White, not
Hispanic or Latino (65.3%, n = 162), followed by Black or
African American (20.6%, n = 51), “Other” (6.9%, n = 17),
Asian (4.4%, n = 11), White, Hispanic or Latino (4.8%, n =
12), Native Hawaiian or Pacific Islander (0.8%, n = 2), and
Native American or Alaskan Native (0.4%, n = 1).
1
Most par-
ticipants were “single” (45.2%, n = 112) or “dating, in
a committed/exclusive relationship (but not engaged) (38.7%,
n = 96). Fewer participants were “married or in a civil union”
(6.9%, n = 17), “dating, but not in a committed/exclusive rela-
tionship” (5.2%, n = 13), or “engaged” (2.8%, n = 7). Nearly
64% (n = 159) of participants identified as straight/heterosex-
ual, 12.1% (n = 30) as bisexual, 4.4% (n = 11) as pansexual/
fluid, 4.4% (n = 11) as asexual, 2.4% (n = 6) as lesbian, 1.6%
(n = 4) as questioning, and .8% (n = 2) as “Other.”
Approximately 1.6% (n = 4) of participants preferred not to
report their sexual identity. Most participants reported having
had vaginal and/or anal sex (72.2%, n = 179).
See Table 1 for a complete report of all correlations.
The intercorrelations among the four conformity dimen-
sions were significant, positive in direction, and ranged in
magnitude from .39 to .74. Conversation orientation was
significantly and negatively related to all conformity dimen-
sions except respecting parental authority (r’s ranged from
−.30 to −.64). Five of the ten correlations among the FCP
patterns and direct and indirect parent sexual communication
were significant, and four of the seven correlations between
FCP patterns, direct and indirect parent sexual communica-
tion, and SHPB intentions were significant.
Path models
The conceptual model (Figure 1) asked whether parent(s)
sexual communication mediated the relationships between
FCP and females’ intentions to engage in SHPB. Our baseline
model (Model 0) demonstrated poor model fit with χ
2
(5) =
19.36, p < .01, RMSEA = .11, CFI = .92, and SRMR = .02
(Figure 2).
Consequently, we ran a saturated model (Model 1) that
added direct paths between FCP and SHPB intentions to
determine whether any FCP were significant direct predictors
of SHPB intentions. The model demonstrated significant
direct paths between experiencing parental control, adopting
parents’ values, and conversation orientation. Since just iden-
tified path models may not be properly evaluated (Holbert &
Stephenson, 2002), we elected to modify our final model to
include the three direct paths (Model 2). Model 2 (Figure 3)
generated excellent model fit, χ
2
(2) = .04, p = .98, RMSEA
< .01, CFI = 1.0, and SRMR = .001. The model accounted for
18.3%, 13.4%, and 27.5% of the variances in parent(s) direct
sexual communication, indirect sexual communication, and
women’s SHPB intentions, respectively.
Regarding connections between FCP dimensions and com-
munication directness, conversation orientation predicted
increased direct sexual communication (H1a was accepted)
(ß = .43, p < .01; Table 2), but it was not significantly predicting
indirect sexual communication (H1b was not accepted). No
conformity orientation dimensions were significantly related
to direct sexual communication (RQ2a). Adopting parents’
values was associated with increased indirect sexual commu-
nication (RQ2b).
In line with our hypotheses, direct communication
(ß = .19., p < .01; H3) and indirect communication (ß = .14,
p < .05; H4) were associated with higher SHPB intentions. H3
and H4 were accepted.
Regarding potential mediation effect of parent(s) direct
(RQ5a, RQ6a) and indirect (RQ5b, RQ6b) sexual
Table 1. Bivariate correlations.
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
(1) Race (White) 1
(2) Sexual intercourse history 0.09 1
(3) Respecting Parental Authority −.15* −0.11 1
(4) Experiencing Parental Control −.17** −0.12 .63** 1
(5) Adopting Parents’ Values −.16* −.15* .68** .74** 1
(6) Questioning Parents’ Beliefs −0.11 −.14* .44** .46** .39** 1
(7) Conversation Orientation −0.04 0.09 −0.11 −.44** −.30** −.64** 1
(8) Direct Sexual Communication 0.04 .17* −0.08 −0.13 −0.08 −.26** .37** 1
(9) Indirect Sexual Communication 0.05 0.04 .17** .28** .30** 0.09 −0.09 .39** 1
(10) SHPB Intentions −0.02 .34** −0.003 0.06 −0.07 −.16* .21** .33** .22** 1
Notes. *p < .05, **p < .001. SHPB = sexual and reproductive health protective behavior.
HEALTH COMMUNICATION 5
Table 2. Standardized path coefficients for Model 2.
Variables ß p
Parent(s) Direct Sexual Communication
Respecting Parental Authority −.13 .16
Experiencing Parental Control .09 .41
Adopting Parents’ Values/Beliefs .12 .22
Questioning Parents’ Values/Beliefs −.003 .97
Conversation Orientation .43 <.01
Race (White) .05 .46
Sexual history .15 .02
Parent(s) Indirect Sexual Communication
Respecting Parental Authority −.13 .18
Experiencing Parental Control .20 .06
Adopting Parents’ Values/Beliefs .31 <.01
Questioning Parents’ Values/Beliefs .03 .79
Conversation Orientation .11 .26
Race (White) .10 .10
Sexual history .09 .16
Intentions to Engage in Sexual and Reproductive Health Protective Behaviors
Parent(s) Direct Sexual Communication .19 <.01
Parent(s) Indirect Sexual Communication .14 .03
Experiencing Parental Control .36 <.01
Adopting Parents’ Values/Beliefs −.27 <.01
Conversation Orientation .21 <.01
Race (White) −.05 .44
Sexual history .29 <.01
Note. In the variable column, bolded are endogenous variables with those indented underneath being predictors.
Figure 1. Conceptual model.
Figure 2. Model 0: proposed full mediation model predicting parent(s) sexual communication and females’ intentions to engage in sexual and reproductive health
protective behaviors. Notes. **p < .01. Solid lines indicate significant path. Dash lines indicate non-significant path. Control variables are not shown for model brevity.
Standardized path coefficients are shown for significant paths only.
6Q. L. WU AND E. PASK
communication, parent(s) direct sexual communication par-
tially mediated the relationship between conversation orienta-
tion and SHPB intentions (RQ5a). Conversation orientation
significantly predicted higher SHPB intentions (ß = .21., p
< .01) but was unrelated to indirect sexual communication.
Therefore, mediation was not present (RQ5b). No conformity
orientation dimensions predicted direct sexual communica-
tion, therefore mediation was not present (RQ6a). However,
indirect communication partially mediated the relationship
between adopting parental values and SHPB intentions
(RQ6b); adopting parental values predicted lower SHPB inten-
tions (ß = −.27, p < .01). Indirect communication did not med-
iate the relationship between any of the other three conformity
orientation dimensions and SHPB intentions.
Additionally, race did not have a significant effect on
parent(s) (in)direct sexual communication; sexual history
was associated with more direct sexual communication and
SHPB intentions (ß = .29, p < .01).
Discussion
This study examined how the family communication environ-
ment and parents’ communication about sex influence
women’s SHPB intentions. Using data from a cross-sectional
survey, we identified direct and indirect factors of SHPB inten-
tions. We also explored the application of the four sub-
dimensions of family conformity orientation. Our study may
help develop sexual health interventions for women. It also
contributes to the theoretical development of FCP.
Theoretical contribution
Following recommendations by Horstman et al. (2018) to
explore more nuanced understandings of family dynamics,
our study validated the four sub-dimensions of conformity
orientation in the context of sexual health communication
within family. Measurements of all four sub-dimensions
showed excellent reliability. Two of the sub-dimensions (e.g.,
experiencing parental control and adopting parental values)
showed direct and indirect relationships with SHPB
intentions.
Research traditionally considered conformity orientation as
unidimensional (Ritchie & Fitzpatrick, 1990), generating
inconclusive findings regarding its impact on health
(Holman & Kellas, 2015; Horan et al., 2018). Some even
emphasized the dark side of conformity orientation due to its
association with poor health outcomes of family members
(Olson et al., 2012). While researchers suggested explorations
to uncover positive functions of conforming behaviors
(Horstman et al., 2018), our findings showed potential benefits
of family conformity orientation.
For example, conformity orientation sub-dimensions
such as experiencing more parental control and adopting
less of parental beliefs directly predicted increased SHPB
intentions. This is in line with the literature, as a meta-
analysis showed that parental control predicted young peo-
ple’s use of contraception (Dittus et al., 2015). Indeed, even
if parents reduce behavioral control as their children grow
older, their control over children’s sexuality may persist,
especially for emerging adult women (Taşkın Sayıl &
Erdem, 2023). Yet, young women are likely to diminish
SHPB such as condom use if they internalize conventional
beliefs about femininity (Impett et al., 2006). Two examples
of such beliefs include inauthenticity in relationships (the
expectations of women to put others’ needs over theirs to
reduce conflicts in relationships) and body objectification
(constant surveillance of women’s body to maintain “lady-
like” physicality). Hence, while communication fosters
shared values and beliefs within families, parents should be
aware of the impacts of their conservative views on their
daughters’ sexual health.
Unlike the other sub-dimensions, respecting parental
authority and questioning parental beliefs did not (in)directly
predict SHPB intentions. This may be due to this study’s
special context. It is possible for college women to act inde-
pendently while respecting parents’ authority at home, regard-
less of parental sex talk strategies. The sensitivity of sexual
topics may also reduce family conversations as a whole
(Grossman, Pearce et al., 2021), limiting the impact of chil-
dren’s tendency to question their parents’ beliefs.
Impact of open/direct family communication about sex
Our study showed that conversation orientation, as well as
families’ direct communication about sex, was associated
with more SHPB intentions. This reflects previous literature
Figure 3. Model 2: final model predicting parent(s) sexual communication and females’ intentions to engage in sexual and reproductive health protective behaviors.
Notes. *p < .05; **p < .01. Solid lines indicate significant path. Dash lines indicate non-significant path. Control variables are not shown for model brevity. Standardized
path coefficients are shown for significant paths only.
HEALTH COMMUNICATION 7
on how open family environment predicted positive (health)
outcomes such as a higher frequency of parents’ sexual educa-
tion (Holman & Kellas, 2015; Horan et al., 2018), daughter’s
sexual health screening efficacy (Gibson et al., 2020), and
a more healthy sexual debut (Faludi & Rada, 2019). Though,
this is not about how the large body of FCP research proved
conversation orientation “right”. Instead, it underlines the
importance to strategically facilitate conversations about sexu-
ality (Wang, 2016).
Role of (In)direct communication
Our findings highlighted the strategy to embrace both direct
and indirect sexual communication (Grossman et al., 2022), as
parents’ direct and indirect communication mediated the
effects of conversation orientation and adopting parental
values, respectively, on SHPB intentions. FCPT suggested
that the family environment can generally influence children’s
attitudes and behaviors (Ritchie & Fitzpatrick, 1990). Our
study furthered this premise by specifying that (in)direct par-
ental communication about sex, stemming from aspects of
FCP orientations, may shape how daughters perceive and
intend to engage in SHPB. While we expected all FCP dimen-
sions to be mediated by the directness of parental communica-
tion, only two mediation paths were significant. This may be
because the conformity orientation sub-dimensions shared
a common factor, reducing their effects on the endogenous
variables.
Even for high conversation-oriented families (Baxter &
Akkoor, 2011), sex can be a difficult topic in parent-child
relationships (Golish & Caughlin, 2002). Sometimes, parental
sexual communication never goes beyond a one-time “sex
talk” (Goldfarb et al., 2018; Padilla-Walker et al., 2020). In
such cases, indirect sexual communication may be helpful to
compensate the insufficient sex talks, as it may allow parents to
convey their sexual attitudes/beliefs more naturally, through
general comments about sexuality in media or among peers
(Grossman et al., 2022). This may particularly apply to high
conformity-oriented families (Koerner & Fitzpatrick, 2002) to
facilitate tactic sex talks, as parents desire comfortable sexual
dialogs with their children (Babayanzad Ahari et al., 2020).
Ultimately, strategic sex education in the family––direct or
indirect––may be related to better sexual health of adult chil-
dren (Faludi & Rada, 2019).
Implications of SHPB intentions
Nevertheless, it is alarming that the women participants
generally had only moderate intentions to engage in SHPB
(M = 4.12). Such intentions were associated with the low
level of direct (M = 2.5) and indirect (M = 2.35) parental
communication about sex. This reflects the prevalence of
STIs among young people (Centers for Disease Control
and Prevention, 2021) and previous research findings about
cultural and religious taboo around sex in families
(Grossman, Pearce et al., 2021). Since FCP may play a role
in young people’s SHPB (intentions), interventions may con-
sider our findings to develop efficient strategies to promote
women’s sexual health.
Limitations and future directions
Our study is not without limitations. First, the cross-sectionality
of this study’s may not guarantee causation. Since FCP may
change as children age (Horstman et al., 2018), future long-
itudinal research can examine whether certain types of parent
sexual communication (e.g., direct and indirect) may be more
effective in promoting children’s SHPB at different developmen-
tal stages. Second, the convenience sample with only female
participants who were primarily young and White at one uni-
versity/location limited the study’s generalizability to educated
young women in the Midwestern United States. Future research
can address this by using more systematic sampling methods.
Third, while parents may use various sexual communication
strategies (e.g., scare tactics, commands), we only examined the
directness of parents’ communication. Future research may
explore the effectiveness of other strategies to better inform
sexual health interventions. Finally, while the scale we used for
measuring SHPB intentions covered a wide range of preventive
behaviors validated in previous research, it did not include pre-
ventive practices during sex (e.g., condom use). Future research
can address this by expanding the measurement for SHPB.
Conclusion
In conclusion, our study explored the relationships among FCP,
family communication strategies about sex, and females SHPB
intentions. The findings validated the application of the four
conformity orientation sub-dimensions in the sexual health
context. Whereas researchers emphasized the role of family
environment in safe sex interventions (Grossman et al., 2022),
our findings suggest that FCP may (not) directly influence SHPB
intentions, but they may indirectly influence sexual outcomes by
shaping family conversations about sex. This may inform future
interventions regarding how families’ communication can be
tailored to improve females’ sexual health protective behaviors.
Note
1. Values exceed 100% because participants could select multiple
racial/ethnic categories.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was not supported by any funding.
ORCID
Qiwei Luna Wu http://orcid.org/0000-0002-6179-9755
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