Mother-daughter Communication Research Articles

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens.

American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes. Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.

Perceptions of Cervical Cancer and Screening Behavior among Cambodian and Lao Women in the United States: An Exploratory, Mixed-Methods Study.

This concurrent mixed method study examined barriers to cervical cancer screening (CCS) among Cambodian and Lao women and mother-daughter communication about women's health, cervical cancer, and screening. We conducted seven focus groups with purposeful samples of Cambodian and Lao women in the Midwest. The participants completed a survey on health characteristics and attitudes about CCS. Focus group data were analyzed using content analysis, and survey data were analyzed calculating descriptive statistics and bivariate hypothesis testing. Predominantly, women spoke about modesty, privacy, and screening only if symptoms were present. More Lao than Cambodian women reported having ever had a Pap smear, significantly higher knowledge about, and greater positive support for completing Pap smears from health providers, family, and friends. Results show cultural similarities among mothers and daughters in communication about women's health, but cultural and generational differences in knowledge, intent, and beliefs about cervical cancer and screening.

Mother-Adolescent Daughter Communication about Sex: Integrative Review

As sexual issues are taboo, it is considered inappropriate to discuss them directly and openly, especially communication about sex between mothers and daughters. Therefore, it is necessary to learn how communication between mothers and daughter about sexual topics can be improved to increase safe sexual behaviors. The purpose of this study is to understand the communication about sex between mothers and their adolescent daughters by conducting an integrative review of qualitative studies. An integrative review of qualitative research studies from 2000 to 2017 was undertaken. Systematic literature searches were carried out on electronic databases for journal articles and doctoral dissertations with full text focusing on mother-adolescent daughter communication about sex. Data was synthesized using thematic analysis. Seven qualitative articles were included in the synthesis, and five recurring themes were identified: 1) Mothers’ attitudes towards talking about sex with daughters 2) Feelings of daughters towards sexual communication with mothers 3) The first-time mother starting to talk about sex with her daughter 4) Contents of sexual communication and 5) Successfulness of communication. Results suggest future research in developing programs to provide communication about sexual matters between mothers and their daughters effectively, including consideration of different cultures and social contexts, is necessary. Keywords : mother-daughter communication, communication about sex, integrative review Address Correspondence to author: Lakkhana Chainok, RN Faculty of Nursing, Thammasat University 99 Klong1, Khlong Neung, Khlong Luang, Pathumthani 12121, Thailand. email: lakkhana014@nurse.tu.ac.th Received: March 23, 2018 Revision received: April 20, 2018 Accepted after revision: July 6, 2018 BKK Med J 2018;14(2): 121-127. DOI: 10.31524/bkkmedj.2018.09.020

Applying a Multifactorial Communication Framework to Better Understand Differences between Father-daughter and Mother-daughter Sexual Health Discussions

While the literature on parent-child sexual communication among adolescent girls is robust overall, research that is specifically focused on communication between fathers and daughters is more limited. Further, there have been calls for work on parent-child sexual communication to be situated within a multi-factorial conceptual framework that distinguishes between different communication components, such as the communication source, content, frequency, quality, and timing. Using such a framework, this study examined aspects of father-daughter sexual communication as they compare to mother-daughter communication in a diverse sample of 193 girls (Mage = 15.62). Results highlighted several gaps between father-daughter and mother-daughter communication. Girls reported covering less content and communicating less frequently about sexual topics with their fathers compared to their mothers. Girls also reported being less comfortable communicating and found their discussions to be less helpful with fathers than mothers. Girls were also less likely to report communicating with fathers about sexual topics before their sexual debut than with mothers. No significant differences were found in communication style (i.e., conversational or like a lecture) between fathers or mothers. Results highlight the importance of understanding the multifaceted process of parent-child communication and signal the need for targeted intervention efforts to improve upon father-daughter communication.

Reproductive health communication between mother and adolescent daughter in Bangladesh: a cross-sectional study

BackgroundParent-adolescent reproductive health (RH) communication is one of the potential sources of information for adolescents on the topic. Given that female adolescents in Bangladesh are faced with increasing RH-related risks, it is important to understand how parents communicate about RH to their adolescents from the adolescents’ perspectives. Therefore, the aim of this study is to explore the status of mother-adolescent daughter communication on reproductive health in Bangladesh.MethodsA cross-sectional study targeting female students was conducted in five high schools in Chittagong based on a self-administered questionnaire survey. A description method was used to describe the characteristics of mother-adolescent daughters’ communication on RH including the frequency, type and the quantity of topics. Bivariate and multivariate logistic regression analyses were performed to explore the factors influencing mother-adolescent daughter communication.ResultsIn the study, 1174 female students aged from 13 to 19 years old were included. The main source of knowledge on RH was from their mother (62%), and the mother was the person who communicated first on RH with adolescent students. The topics of mother-daughter communication were mainly focused on menstruation issues (> 80%). Multivariate logistic regressions showed that Hindu students, students with good RH knowledge, adolescents’ mothers having good RH knowledge, mothers with high media use, good mother-daughter relationship, daughters’ regular general communication with mothers, and students’ perceiving comfort in RH communication with their mothers were reported as significant predictors for a good RH communication status. On the contrary, students having family members numbering more than four, whose primary source of reproductive health information was friends/classmates as well as media were less likely to have better RH communication with mothers.ConclusionsThe overall communication on reproductive health between adolescent daughters and their mothers was not good. This study suggests for conducting qualitative research investigating the socio-cultural context within which the RH communications happen. and how to address the obstacles that might hinder this communication.

Mother-Daughter Communication about Sexual Behavior and Reproductive Health in Females with Chronic Health Conditions

PurposeFemales with chronic health conditions (CHCs) engage in risky sexual behavior at least as frequently as their healthy counterparts. Among healthy youth, mother-daughter communication about sexual behavior and reproductive health protects against risky sexual behavior. Yet, little is known about the nature of this type of communication in female adolescents with CHCs or factors that contribute to communication. This study described mother-daughter communication frequency, timing, and comfort and examined the role of demographic/disease factors and maternal outcome expectancy (OE), in contributing variance to mother-daughter communication about risky sexual behavior and reproductive health. Design and methodsOne hundred mother-daughter dyads from outpatient clinics located within a hospital participated. Daughters [ages 14–19; M(SD) age = 16.28 (1.53)] provided demographic information and mothers self-reported frequency, timing, comfort, and OE of mother-daughter communication about sexual behavior and reproductive health. ResultsReproductive health topics were discussed with the greatest frequency. Condom and birth control use were discussed less often. Overall, maternal comfort levels were high across topics. Maternal positive OE was associated with all communication domains, accounting for between 11 and 21% of the variance beyond relevant demographic factors. ConclusionsFostering positive maternal OE may enhance multiple domains of mother-daughter communication about sexual behavior and reproductive health in samples of female adolescents with various CHCs. Practice implicationsSince mothers with positive OE talk about sexual behavior earlier, more frequently, and with greater comfort; nurses are in a unique position to empower mother-daughter communication about sexual behavior and reproductive health and enhance mother OE during clinical encounters.

College women’s sexual and reproductive health screening behaviors and the role of mother–daughter communication

Objective: The study investigated the role of mother–daughter communication and race in college women’s decisions to pursue sexual health screening services. Participants: Participants were 301 college women who primarily identified as White and Asian American (Mage = 19 years). Methods: Participants completed an online survey that assessed mother–daughter communication about sex and responded to items pertaining to pursuing sexual health screening services. Results: Maternal communication predicted daughters’ screening behaviors and sexual anxiety mediated the negative association between conservative communication from mothers and screening behaviors. Asian American college women were less likely than White college women to report that they received frequent and open communication about sex from their mothers and reported higher levels of sexual anxiety. Conclusions: Mothers should be aware of the implications their communication patterns may have on their daughters’ sexual and reproductive health, and college women’s sexual anxiety should be addressed in order to increase utilization of screening services.

Reducing Risk for Gestational Diabetes Mellitus (GDM) Through a Preconception Counseling Program for American Indian/Alaska Native Girls: Perceptions From Women With Type 2 Diabetes or a History of GDM.

Purpose American Indian and Alaska Native (AIAN) women are disproportionately affected by gestational diabetes mellitus (GDM). GDM is a risk factor for subsequent diagnosis of type 2 diabetes (T2D) in both mother and offspring, yet there is minimal research being conducted in this population. The purpose of this portion of a larger 5-year study is to examine AIAN women’s experiences of having GDM or T2D during pregnancy, inform the development of a GDM risk reduction and preconception counseling (PC) program tailored to AIAN girls, and enhance mother-daughter communication and support within the program. Methods AIAN women with TD2 or a history of GDM (N = 5) were interviewed to understand their unique perspectives on diabetes and pregnancy, behaviors to reduce risk, and content for a PC education program for AIAN girls. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparison method to construct themes across the interviews. Results Four primary themes were constructed: lack of knowledge on GDM and GDM risk factors, importance of AIAN culture for health and wellness, suggestions for communication with AIAN girls to reduce risk of GDM, and the emotional impact of GDM diagnosis. Conclusions Participants wished they had known about risk factors for GDM and how to reduce their own risk of developing GDM. Findings from this study have been used to adapt an existing PC program, originally developed for non-AIAN girls with diabetes, for AIAN girls who do not have diabetes but have risk factors for developing GDM in future pregnancies.

Missed opportunities for HIV prevention: Results of a qualitative study on mother-daughter communication

This qualitative study examines the role of communication among African American mothers living with HIV and their daughters in HIV prevention. Multiple themes emerged from our analysis of semistructured interviews with mothers (n = 15), and their adult daughters, (n = 15) such as perceptions of HIV risk communication, HIV/AIDS knowledge, attitudes, and beliefs. The findings of the study revealed differences in communication between mothers and daughters. Daughters felt they did not receive adequate and frequent HIV prevention advice from their mothers. Implications include strengthening communication content between mother-daughter dyads in HIV prevention programs that can aid in reducing HIV risk.

Mother–daughter communication and health: A cross-cultural comparison

Mother–daughter communication about health is one of the most important experiences that young women can have to promote a healthy lifestyle, but the success of that communication depends on a variety of factors. Three factors that influence health motivation and behavior were examined in this study: (1) the frequency mothers and daughters communicate about health, (2) the quality of those interactions, and (3) their country. Participants were 168 female college students (74 from Jamaica and 92 from the United States) who completed online surveys regarding the relationship with their mothers, how often they talked with their mother about a variety of health topics, how they were motivated, and how often they engaged in healthy and unhealthy behaviors. Both the frequency and quality of interactions about health were important, but this effect was stronger for Jamaican women than for Americans. Implications for health research regarding culture and relationships are discussed.

Understanding Mothers And Daughters Physical And Emotional Health

Compared to boys, adolescent girls have a higher prevalence of obesity, are more sedentary, and suffer more from psychosocial distress. It has been theorized that girls imitate their mothers’ body image concerns and physical activity habits. PURPOSE: The aim of this study was to explore the relationship between adolescent girls’ and mothers’ perceived physical and emotional health. METHODS: Adolescent girls (N = 44) and their mothers (N = 19) participated in seven and four focus groups, respectively. Each focus group lasted 30-45 minutes and included an average of six and five participants for girls and mothers, respectively. Questions focused on physical activity behaviors of mothers and daughters as well as their perceptions of body image and self-esteem. The focus groups were analyzed using “Framework Analysis”. Intercoder reliability was addressed through an iterative coding process (initial coding, code modification, recoding) whereby three of the authors developed and agreed upon the codes and subsequent collapsed themes. RESULTS: The thematic analysis resulted in four major themes and five subthemes: 1) Health related conversations are complex and result in a) daughters feeling frustrated and b) mothers feeling confused, 2) Social expectations influence body image through a) social networks and b) women’s changing bodies, 3) Social comparison is common in women and girls in a) their comparison of one another which b)influences the daughter’s perception of herself, and 4) Mothers’ health behaviors are noticed by daughters who report very little physical activity participation with mothers. CONCLUSION: Results from this study highlight the type of health communication that mothers and daughters perceive as most challenging; daughters struggled with indirect conversations with their moms about health, whereas their mothers struggled with direct communication about health. Potential implications of this research include the support for targeting mothers, in addition to adolescent girls, in interventions aimed at improving mother-daughter communication as well as adolescent girls’ health. Other possible implications include targeting psychosocial health (e.g., body image) and including a mothers’ educational component for programs aimed at improving adolescent girls’ health.

Can Mother–Daughter Communication Buffer Adolescent Risk for Mental Health Problems Associated With Maternal Depressive Symptoms?

The current study sought to test whether higher quality mother–daughter communication would buffer associations between maternal depressive symptoms and girls’ internalizing and externalizing psychopathology symptoms among urban African American girls across a 12-month period. One hundred ninety-four treatment-seeking urban African American adolescent girls, ages 12–16, and their mothers participated in the study. Every 6 months (for up to 3 assessments), daughters reported on their internalizing and externalizing symptoms, mothers reported on their depressive symptoms, and both mothers and daughters reported on the quality of their dyadic communication. Daughters additionally reported on the extent to which they felt accepted by their mothers at each assessment. Results of multilevel modeling revealed that quality of communication significantly interacted with maternal depressive symptoms to predict externalizing and internalizing symptoms in daughters, such that the risk associated with maternal depressive symptoms was fully buffered for daughters in high-quality communication dyads. Secondary analyses demonstrated that these patterns of results were not accounted for by higher levels of social status or maternal acceptance. Drawing on a vulnerable and understudied population of urban African American adolescent girls, this work suggests that family communication may contribute to important intergenerational psychopathology transmission processes, above and beyond more general features of the family environment.

Motives, barriers, and ways of communicating in mother-daughter sexuality communication: a qualitative study of college women in Tanzania

In Tanzania, young women aged 15–24 are at high risk for HIV and nearly half (45%) of women experience pregnancy or childbirth before age 19. The HIV epidemic has motivated many parents to overcome cultural taboos and talk with their children about sexuality, but few studies in Tanzania have examined how young adults perceive these discussions. In-depth interviews with 31 Tanzanian college women (ages 18–25) reveal how they make sense of sexuality messages from mothers that are sometimes vague, admonishing and fear-based. Participants identified how mothers focused on the health, educational and social consequences of premarital sex and emphasised the avoidance of men as a strategy to maintain virginity. Mothers avoided providing specific information about safer-sex practices, or strategies to negotiate romantic relationships, sexual pressures or sexual desires. Findings offer insight into how relational and cultural contexts influence mothers’ sexual socialisation and can inform education and intervention approaches that consider the changing cultural landscape. Future qualitative research with mothers is recommended to develop programmes that are more responsive to mothers’ and daughters’ needs.

Young adult women’s narrative resilience in relation to mother-daughter communicated narrative sense-making and well-being

Grounded in communicated narrative sense-making (CNSM) and resilience theorizing, the current study investigated the effects of mother-daughter communication on young adult women’s ( n = 60) narrative construction of resilience over time. Participants wrote stories of difficult experiences at Time 1, discussed the story with their mother in a research lab two days later, and wrote the story again at Time 2. Inductive analyses of daughters’ stories revealed four themes of resilience: acknowledging the struggle, taking action, seeking silver lining, and finding strength in others. Mother-daughter interactions were analyzed for CNSM behaviors—engagement, turn-taking, perspective-taking, and coherence. Mother-daughter coherence and engagement illuminated differences in daughters’ themes of resilience, and all CNSM behaviors positively related to daughters’ increased narrative resilience over time. Findings demonstrated the effect of mother-daughter interaction on young adult women’s resilience, suggesting that CNSM contributes to the meaning-making component of resilience. Implications for advancing CNSM and resilience theorizing are explored.

Effect of communication skills based group counseling on mothers' sex dialogue with their adolescent daughters.

Background Sex dialogue is one of the most critical and challenging topics between mothers and adolescents. The knowledge and skills of mothers in sex dialogue with their daughters are essential. The purpose of this study is to determine the effect of group counseling based on communication skills on mothers through their sex dialogue with their daughters. Methods A randomized controlled field trial was conducted on 168 couples of mothers and their daughters selected by the stratified matching method and randomly divided into two control and intervention groups. The mothers in the intervention group participated in a communication-based consultation in groups consisting of 6-12 people for 6-7 weekly sessions, each one lasting 60 min. The data collection tool was a Persian-translated questionnaire by Jaccard for sex dialogue between mother and daughter. The data were analyzed using Chi-square (χ2), ANOVA with repeated measures and modified post hoc Bonferroni tests. Results There was a significant difference in the mean score of mother-daughter sex dialogue 1 week after intervention between the intervention (34.48 ± 8.74) and control (40.44 ± 9.49) groups (p = 0.001) and 1 month after the intervention between the intervention (30.41 ± 10.07) and control (42.47 ± 9.62) groups (p < 0.001). Conclusion Through applying communication skills, an increase in mother-daughter sex dialogue frequency was observed after group counseling. Therefore, it is suggested to promote mother-daughter communication skills by accessing the mothers via schools, health centers and with the aid of midwifery counselors, midwives and other trained caretakers.

Sexual risk among African American girls seeking psychiatric care: A social-personal framework.

This study examined individual and social factors associated with sexual risk behavior among African American girls seeking outpatient mental health services across 2 years and key developmental transitions. African American females 12-16 years old (M = 14.5; SD = 1.15; n = 266) were recruited from eight outpatient mental health clinics and completed interviewer-administered and computer-assisted measures at baseline, 12, and 24 months. Analyses tested individual attributes (externalizing and internalizing problems) and family context (maternal acceptance-rejection, mother-daughter communication about sex) at baseline, peer influences (peer support of substance use, girlfriend dating behavior) and partner relationship characteristics (rejection sensitivity, partner risk communication frequency and openness) at 12 months, and girls' sexual behavior at 24 months. At baseline, 32% of girls reported having had vaginal/anal sex compared with 60% at 24 months. Data analyses revealed robust associations between externalizing problems and maternal acceptance-rejection and mother-daughter risk communication during early adolescence, peer support of substance use and girlfriend dating behavior 1 year later, and girls' sexual risk taking 2 years later. Findings support a social-personal framework (SPF) of sexual risk for African American girls seeking mental health care, underscoring the potential benefits of early intervention to reduce externalizing problems while strengthening mother-daughter communication and relationships to prevent subsequent sexual risk and associated negative outcomes. (PsycINFO Database Record

A cross-national study of intergenerational influence: US and PRC

PurposeThe purpose of this study is to examine the intergenerational influence across dyads of mothers and daughters from the USA and the People’s Republic of China (PRC), with a particular interest in discovering the cross-national differences in terms of the level of mother–daughter brand preference agreement, the directional influence from daughter to mother and leading factors for the observed differences.Design/methodology/approachUsing a parallel survey method, responses were obtained regarding participants’ brand preferences, as well as their perceptions of their dyad partners’ preferences, for 20 product categories. A total of 76 dyads in the USA and 114 dyads in the PRC were collected.FindingsResults not only confirmed the existence of intergenerational influence in mother–daughter dyads’ brand preferences after removing the nominal bias that previous studies commonly suffered but also suggested two interesting cross-national differences. Specifically, the authors find that US mother–daughter dyads possess a higher level of brand preference agreement than their PRC counterparts; however, the influence from daughters to mothers in the PRC is greater than in the USA. The authors further find that two potential leading factors contribute to the observed cross-national differences; mother–daughter communication is stronger but less influential in the USA than in the PRC, while children’s peer influence, measured as information influence of peers, is weaker but more influential in the USA than in the PRC.Research limitations/implicationsUnderstanding intergeneration influences in different cultural contexts may be applicable in developing communication strategies leading to brand preference.Originality/valueThis study contributes to the consumer socialization literature by examining the cross-national differences of intergenerational influence in brand preferences and their leading causes of such differences in the context of the two biggest economies.

Mother-Daughter Communication on Intimate Relationships: Voices from a Township in Bloemfontein, South Africa

Sex education and conversations about intimate relationships are generally regarded to be important and can contribute to young women’s positive or negative reproductive health development and general well-being. The findings contained in this article suggest that in a resource poor South African township, mothers and their daughters struggle to initiate and conduct meaningful discussions about sex. These discussions are often framed in terms of possible negative consequences of intimate relationships, such as unplanned pregnancy, dropping out of school, or possible Human Immunodeficiency Virus (HIV) infection. However, these discussions are clearly not altogether effective as several young research participants had an unplanned baby. Emotional aspects that are normally associated with intimate relationships are missing from the mother-daughter conversations.

Prevalence of communication between mothers and daughters on sexuality and associated factors in Sagamu, southwest Nigeria.

As adolescents transition from childhood to adulthood, effective mother-daughter communication on sexuality plays a role in reducing high-risk behaviours linked to human immunodeficiency virus (HIV) infection and early pregnancy and childbirth. The objective of the study was to examine the prevalence of mother-daughter communication on sexuality and associated factors in Sagamu, southwest Nigeria. Using multistage sampling, surveys were conducted using 234 female youth enrolled at a secondary school. The chi-square or Fisher's exact test was used to examine associations between categorical variables. The independent sample t-test was used to compare mean values of variables with reported evidence of mother-daughter communication on sexuality. The mean age of respondents was 16+1.56 years. The majority (89.7%) had engaged in mother-daughter communication on sexuality, but three-quarters (80.8%) of the respondents could not freely discuss sexuality with their mothers. About one-third (31.6%) of the respondents reported at least one sexual encounter with the mean age of sexual debut of 14.23±2.12 years. Mother-daughter communication on sexuality was significantly associated with religion (p=0.047), mother's age (p=0.019), who the respondents live with (p=0.029), mother's highest educational status (p<0.001), age of sexual debut (p=0.030), and condom use (p<0.001), but not with freedom to discuss sexuality with their mother (p=0.552) or freedom to introduce male friends to their mother (p=0.077). Despite the high prevalence of mother-daughter communication on sexuality, mothers' approach appeared unfriendly, as most girls could not freely discuss topics concerning sexuality with their mothers. Poor communication on sexuality was associated with sexual risk behaviours. Mothers should engage in adolescent-friendly transferring of knowledge on sexuality in order to reduce pregnancy rates and HIV transmission in female adolescents.

Experiences of "openness" between mothers and daughters during breast cancer: implications for coping and healthy outcomes.

Mother-daughter communication is central to how women adjust to breast cancer. They may be aided by models of healthy communication that illustrate both women's perspectives. Families establish normative communication patterns that inform how they cope. We used family communication patterns theory to examine correlations between openness/avoidance and health. We extended this by capturing mother-daughter open/avoidant narratives to illustrate how these behaviors function in helpful (health-promoting) and unhelpful ways. Phase 1 of this mixed-method study involved 41 patients and 37 mothers/daughters (N=78) completing surveys on mother-daughter openness, avoidant coping, and quality of life. Phase 2 involved interviews with 40 patients and 38 mothers/daughters (N=78) to ascertain what diagnosed women share (or do not share) with their mother/daughter and their reasons. Diagnosed women reporting more open mother-daughter bonds had better relational health (r=.730, P<.001). Those who engaged in more avoidant coping reported poorer physical health (r=-.431, P=.01). Mothers and daughters talked about treatment side effects and procedures, disease risk and prevention, and medical decisions. They avoided discussions about distressing emotions and topics as well as uncertainty about the future. Motivations to disclose/avoid centered on protecting themselves and/or their mother/daughter. Qualitative findings illustrate the tension between openness and avoidance. Developmental differences and relational role perspectives illustrate women's diverse needs. A history of openness is linked with relational health, but coping is not as simple as "be open." Both openness/avoidance are helpful and unhelpful depending on age, topic, and responses.