Interventions aimed at parents need to reach and engage them. This can be difficult in community settings where many parents must make a special effort to attend (37). Parent training programs on various topics generally have high dropout rates, ranging from about 25% to more than 40% (38,39). A promising alternative is to bring the intervention to parents where they work, an approach that may facilitate recruitment and retention (40). Worksite-based health programs, such as weight reduction (41) and smoking cessation (42), have been successful in changing employees' health-related behaviors. Although some employers have programs to help employees with family issues, few have programs designed to address the needs of parents of adolescents. Talking Parents, Healthy Teens addresses this gap.

Additional advantages of the worksite setting include having the support of the workplace management, which can serve as a form of "approval" that makes the parenting program more inviting to employees. Finally, worksites may provide an infrastructure that makes them an easier setting than others for implementing Talking Parents, Healthy Teens or similar programs. 

In developing the parenting program, we 1) reviewed and adapted curricula of parenting programs (general programs and programs covering parent–adolescent communication) and adolescent programs; 2) consulted with researchers and educators with expertise in adolescent behavior, parenting, health promotion, and adult learning principles; 3) conducted focus groups with parents and adolescents and interviews with worksite representatives (43); and 4) piloted the program at three worksites and then revised it based on our experiences.

In 1991, the leading proponents of behavior change theories dominating HIV-related research (e.g., social learning theory, health belief model, theory of reasoned action) came to consensus on the eight variables that most strongly influence behavior change (44). They identified three factors as necessary and sufficient: 1) an individual’s skills or ability to engage in behavior; 2) an individual’s intentions to engage in behavior; and 3) the absence of environmental barriers that prevent behavior or the presence of resources (facilitators) to engage in behavior. Five additional factors have both a direct and an indirect effect on behavior by influencing intentions: 4) perceived self-efficacy; 5) perceived social norms; 6) perceived net benefits; 7) perceived consistency with personal standards (i.e., behavior is consistent with self-image); and 8) emotional response (i.e., emotional reaction to behavior is more positive than negative). Knowledge and beliefs also influence these five factors.

We applied these eight factors to Talking Parents, Healthy Teens (Figure) and hypothesized that parents would change their parenting behaviors, which would lead to a change in adolescent behaviors. Talking Parents, Healthy Teens aims to influence parents' skills such as communication, monitoring, and involvement; intentions to talk about sex, monitor, and stay involved; and perceptions of environmental barriers and facilitators that influence talking about sexuality (e.g., community norms that discourage or encourage such communication). By increasing parents' skills and facilitating opportunities for communication through take-home activities, the program also aims to affect the parent–adolescent relationship, further influencing adolescent behavior change (e.g., the likelihood that adolescents will delay intercourse or use condoms).

Other examples illustrate the types of interactions captured by the theoretical model:

Talking Parents, Healthy Teens is a parenting program for parents of sixth to tenth graders. It consists of eight weekly 1-hour sessions presented during the lunch hour to groups of about 15 parents. A trained facilitator and assistant facilitator lead the program using a standardized, scripted, program manual. We provide lunch, which serves as an incentive for participation and reduces late arrivals. The program is interactive and focuses on building parents' abilities, comfort, and confidence; lecturing is minimal. Sessions focus on skill-building and practice. Each session builds on previous ones; the facilitator reviews the prior week's lessons and troubleshoots issues that arose when parents used new skills at home. We mail materials to parents who miss sessions (usually through interoffice mail at the worksite), and the facilitator reviews the session content with absent parents by telephone.

The program acknowledges that parents have diverse experiences and backgrounds; values, and moral and religious beliefs; and levels of comfort addressing sex-related topics. It is designed so that parents can apply what they learn to achieve their goals. We teach skills, facts, and options and offer advice for how and when to talk to children, but we do not dictate to parents what they should do or how they should feel. For example, to provide balance for parents with diverse views, the same session covers how to say no to sex and how to use a condom. We have had favorable feedback from parents who want their children to refrain from sex until marriage and parents who are comfortable with their high-school-aged adolescents having sex (with contraception).

Communication skills are a major program feature. For example, parents learn how to start and sustain conversations on sensitive sex-related topics, how to ask questions, and how to listen without lecturing. After parents learn basic communication skills, they learn skills that they can teach their children. The facilitator reviews the elements of each skill and provides examples illustrating its use and benefits. Volunteers read aloud parent–child dialogues that use (or fail to use) the skill, and then all parents practice the skill in role-plays.

Between sessions 4 and 7, parents meet individually with the facilitators for a private session to practice the skills and receive feedback. The parent and one of the facilitators, who plays the role of the adolescent based on the parent's description of his or her child, engage in a role-play about a sex-related topic. The role-play is videotaped so that the facilitators can review it with the parent. Parents observe their tone, word choice, and body language in what can be an eye-opening exercise. They then develop a plan to improve their communication.

Each week, parents receive a set of short activities to help them practice new skills at home. Some exercises help parents think about important issues related to their adolescents (e.g., appropriate supervision), and some help parents communicate with adolescents by providing games to play and sex-related topics to discuss (Table).

Parents receive the following handouts during the program: 1) facts of life, which cover topics such as puberty, contraception, HIV and other STDs, sexual orientation, and alcohol use; 2) communication skills, which summarize communication skills taught during the sessions; 3) parenting tips, which provide additional examples of parenting strategies; 4) worksheets, which are used for in-class exercises that help parents learn program material; 5) key ring cards — short outlines of communication skills printed on small laminated cards and attached to a key ring — used so that parents can keep skill summaries handy; and 6) a parenting resource list that includes hotlines, books, and other resources. Parents also receive a participant notebook in which to keep handouts and notes.

Raffles with prizes (e.g., a teen sexual health book) are held during the program. At the end of the program, parents receive a certificate for course completion that provides a marker of their accomplishment and encourages continued work on parent–child relationships.

Overview. Session 1 provides an overview of the program and reasons for offering it. The session focuses on positive parent–child relationships, covering points that are reinforced in later sessions: the importance of 1) talking to children about sex; 2) establishing a quality parent–child relationship; 3) identifying and reinforcing children's strengths; 4) spending time with children; 5) helping children develop future goals; and 6) supervising children.

Communication skills. Parents are encouraged to praise or reinforce their children's strengths by "catching their child doing something good" (i.e., noticing a positive behavior and making a favorable comment to the child about it).

Overview. Session 2 focuses on the importance of being involved in the adolescent's life and reinforces positive parent–adolescent relationships. By discussing adolescent physical, social, emotional, and cognitive development, parents learn that some adolescent behaviors that are baffling and frustrating may be a normal part of development. They are reminded of how physical changes may affect the way adolescents feel about themselves and that an adolescent's sexual and romantic feelings are developing. The topic of sexual orientation is introduced.

Communication skills. Parents are introduced to two skills. 1) "I" messages are statements parents make that include the phrase, "I feel. . . ." For example, "When you play your music loudly, I feel annoyed because I can't get my work done." These messages do not label or blame the adolescent; they focus on the parent's feelings and not on the adolescent's misbehavior. "I" messages can reduce the likelihood that conflict will escalate. 2) Strategies for inviting children to talk (e.g., offering several examples of what a person might feel in a given situation to help adolescents identify and discuss their own feelings) can increase the likelihood of general conversation and may be particularly helpful to parents whose children frequently give responses like "uh huh." The program reinforces the value of having general, nonspecific conversations with adolescents in addition to engaging in specific conversations about sex. The facilitator addresses parents' inability to make children talk if they do not want to and the value of spending time together engaged in activities.

Overview. Session 3 focuses on listening to adolescents and addresses parents' concerns about talking about sex. Parents identify and discuss reasons why they might be reluctant to talk with their children about sex (e.g., fear that talking about sex might encourage it, that the child is too young to talk about it, that they might disclose more about their own past than they want to). By addressing these concerns, parents develop the confidence to talk to their children about sex.

Communication skills. Parents learn an approach called active listening, which involves paying attention, listening without interrupting, restating what they have heard their children say (to confirm they understood correctly and to show they were listening), and identifying the feelings their children are expressing. Active listening shows youth that parents are interested, encourages youth to express themselves, and helps them identify their own thoughts and feelings. In conversations about sex, this communication skill increases the likelihood that parents and adolescents will engage in a balanced discussion instead of an intervention in which the parents lecture and the adolescents say little.

Overview. In Session 4, the program moves from skills that promote general communication and positive parent–child relationships to skills that support communication specifically about sex. Although many parents have a vague feeling that they do not want their child to have sex, they may not have identified their specific beliefs or considered how they feel about dating and sexual behaviors that might occur before or instead of intercourse. Identifying their beliefs helps parents consider what messages they want to convey.

Communication skills. Parents are introduced to four strategies to initiate conversations about sex: 1) using teachable moments (i.e., everyday situations, such as watching a movie with a love scene, that provide opportunities to start discussions); 2) thinking of opening lines to start the conversation; 3) identifying roadblocks (e.g., what adolescents say to make it hard to talk about sex) and strategies such as open-ended questions to get past them; and 4) identifying reasons they want to talk about sex with their children and learning how to avoid lecturing. By practicing how to start conversations through role-plays, parents gain experience and confidence so they can talk to their children more easily.

Overview. Session 5 focuses on developing abilities to engage in longer conversations about sex-related topics with adolescents. Parents think about the reasons that adolescents might and might not want to have sex. By considering the adolescent perspective on sexual matters, parents can anticipate potential adolescent responses and work to make their discussions proceed smoothly.

Communication skills. Parents are presented with reasons why it is important to help children learn how to make their own healthy decisions about sexual behavior rather than dictating to them what to do. Parents are introduced to decision-making skills that involve the parent asking the adolescent questions to help the adolescent develop decision-making skills. These decision-making skills are called the S.T.O.P. steps: State the decision; Talk about feelings and needs; brainstorm and discuss Options; and Pick the best option and later evaluate it.

Overview. The first part of Session 6 covers assertiveness skills for adolescents who want to remain abstinent from sexual activity in general or refrain from some or all sexual activities in a particular situation. The second part of the session addresses various methods of preventing STDs or unintended pregnancies among adolescents who engage in sexual activity. Parents discuss advantages and disadvantages of condoms and how they would talk to their children about them. The facilitator demonstrates how to use a condom by putting it on two fingers, and parents have the opportunity to practice how they would teach their adolescents the steps for correct condom use.

Communication skills. Parents learn assertiveness skills so that they can teach them to their children: how to say no to someone who is applying pressure in an unwanted sexual situation; how to suggest an alternative activity as a means of getting out of a pressured situation without implying a desire to end the relationship (e.g., proposing to go to the movies instead); and delay tactics or methods of cooling down a pressure situation (e.g., going to the restroom). Not only do parents engage in role-plays in which they practice responding to someone who is pressuring them, but they also are encouraged to use these role-plays at home with their adolescents.

Overview. Session 7 addresses strategies for negotiating conflict. Parents learn additional assertiveness skills that adolescents can use if they decide to have sex and want to use contraception. Parents review the program skills that can be used to cope with conflict. For example, they are shown how the S.T.O.P. steps from session 5 can be used to resolve problems and reduce conflict with others. Parents also discuss their supervision practices and how to supervise their children appropriately in various situations. Finally, parents discuss what it means to "respect others" and how they can help their children understand concepts such as "no means no."

Communication skills. Additional assertiveness strategies that parents learn to teach adolescents include stating that they want to use a condom, giving a reason why they want to use a condom, coming up with a response that they can use if pressured to have sex without a condom, saying no to sex without a condom, and using alternative actions and delay tactics.

Session 8 reviews the communication and parenting skills learned in the prior seven sessions, motivates parents to continue using these skills, and acknowledges parents' efforts and participation. Parents have the opportunity to practice all of the skills they have learned during the program in a variety of role-plays. They are encouraged to stay in touch with and support each other, to remember to "catch themselves doing something good," and to identify the next conversation they intend to have with their child about sex or sexuality. Finally, rewards for perfect attendance and certificates of participation are distributed. Parents also receive the parenting resource list.