Parent-adolescent Communication Research Articles

Links among Mothers’ Dispositional Mindfulness, Stress, Perspective-Taking, and Mother-Child Interactions

How parents think about their internal states and about their emotional experiences impacts their parenting. Parents who demonstrate dispositional mindfulness, the capacity for open awareness and attention in the present moment, experience lower levels of stress. The present study assessed whether mindful parents may show more positive parenting and be perceived more favorably by their children in parent-child interactions. One hundred and twenty-seven mothers completed measures assessing mindfulness and stress, and their early adolescent children (M age = 10.87 years; SD = 0.90) completed measures assessing their mothers’ perspective-taking, and disclosure to and conflict intensity with their mothers. Using path analysis, we found that mothers’ greater dispositional mindfulness was associated with adolescent reports of greater maternal perspective-taking through less maternal stress. Further, mothers’ greater dispositional mindfulness was associated with more adolescent disclosure to mothers and less intense conflict through less maternal stress and greater maternal perspective-taking. Our results suggest that mothers’ stress and perspective-taking may indirectly link parent mindfulness and adolescent perceptions of parent-adolescent communication.

Determining the feasibility of an online, media mediation program for parents to improve parent-child sexual health communication

Media Aware Parent is an interactive, web-based program designed to equip parents to communicate with their adolescent child about sexual health and media by enhancing parental communication and media mediation skills, as well as provide them with medically-accurate sexual health knowledge. In a small feasibility study, 56 parents of 7th and 8th graders in the United States were randomly assigned to complete a prototype of Media Aware Parent or receive online resources about adolescent sexual health. Results indicated that after using the program, participants in the intervention group discussed more new sexual health topics with their child and also had stronger beliefs in the importance of parent-adolescent communication (PAC) about sexual health when compared to the control group.

Latino STYLE: Preliminary Findings From an HIV Prevention RCT Among Latino Youth.

Latino STYLE is a family-centered, HIV-focused intervention (HIV) emphasizing cultural factors and parent-adolescent communication. We hypothesized that, compared with a general health promotion (HP) intervention, the HIV arm would improve caregiver and adolescent HIV knowledge, attitudes, parental monitoring, sexual communication, and family relationships after a 3-month postintervention period. This article reports on the short-term findings of the longer trial. A single-site, two-arm, parallel, family-based, randomized, controlled trial was conducted; eligible participants were Latino adolescents aged 14-17 and their primary caregiver. The study was conducted at the University of South Florida with 227 adolescent-caregiver dyads allocated to the HIV (n = 117) or HP (n = 110) intervention after completing a baseline assessment. Interim measures at 3-month follow-up included demographics, HIV knowledge, self-efficacy, parental monitoring, sexual communication, family relationships, and adolescent sexual behavior. Adolescents in the HIV group reported small effects in parental permissiveness and the HP group reported small effects for family support. Caregivers in both groups reported decreases in all outcomes. Incidence of past 90-day sexual intercourse decreased in both treatment arms. Among those who were sexually active over the past 90 days, the number of sex acts decreased from baseline, particularly in the HIV group. The percentage of condom-protected sex acts increased in the HIV group and decreased in the HP group, but did not reach statistical significance. The HIV Latino STYLE intervention was not efficacious in improving hypothesized outcomes over a 3-month period. However, exploratory analyses revealed moderate effects for decreases in adolescent sexual risk behavior, particularly in the HIV group.

Utilizing a Life Course Approach to Examine HIV Risk for Black Adolescent Girls and Young Adult Women in the United States: A Systematic Review of Recent Literature.

Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this population during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key developmental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psychosocial, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women. Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States. In total, 21 studies met the inclusion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies assessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities. Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledgment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed.

How Does Family Communication Relate to Adolescent Dating Violence and Externalizing Behaviors? The Role of Parent-Adolescent Risk Communication and Attitudes toward Violence in a Nicaraguan Sample

ABSTRACT Family plays a critical role for adolescent socialization. Parents in particular can promote either adolescent prosocial or problem behaviors. The purpose of the present study is two-fold. The first is to investigate the main and interaction effects of family communication (i.e., verbal hostility and expressiveness) on adolescent risk behaviors (i.e., dating violence and externalizing behaviors). The second is to test whether family communication is indirectly associated with adolescent risk behaviors through parent-adolescent risk communication and adolescent attitudes toward violence. Nicaraguan 7th and 8th graders were recruited to participate in paper-pencil surveys (N = 1,651). Path analysis identified significant main effects of verbal hostility for adolescent dating violence and externalizing behaviors. Although expressiveness did not show a significant main effect, interaction effects with verbal hostility were identified for both dating violence and externalizing behaviors. When verbal hostility was low, expressiveness was negatively related to adolescent dating violence and externalizing behaviors whereas when verbal hostility was high, expressiveness was positively associated with these behaviors. Significant indirect effects were detected only via adolescent attitudes toward violence. Prevention efforts that promote positive family environments and especially that eliminate verbal hostility are suggested.

Cross-Cultural Examination of Links between Parent\u2013Adolescent Communication and Adolescent Psychological Problems in 12 Cultural Groups

Internalizing and externalizing problems increase during adolescence. However, these problems may be mitigated by adequate parenting, including effective parent–adolescent communication. The ways in which parent-driven (i.e., parent behavior control and solicitation) and adolescent-driven (i.e., disclosure and secrecy) communication efforts are linked to adolescent psychological problems universally and cross-culturally is a question that needs more empirical investigation. The current study used a sample of 1087 adolescents (M = 13.19 years, SD = 0.90, 50% girls) from 12 cultural groups in nine countries including China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States to test the cultural moderation of links between parent solicitation, parent behavior control, adolescent disclosure, and adolescent secrecy with adolescent internalizing and externalizing problems. The results indicate that adolescent-driven communication, and secrecy in particular, is intertwined with adolescents’ externalizing problems across all cultures, and intertwined with internalizing problems in specific cultural contexts. Moreover, parent-driven communication efforts were predicted by adolescent disclosure in all cultures. Overall, the findings suggest that adolescent-driven communication efforts, and adolescent secrecy in particular, are important predictors of adolescent psychological problems as well as facilitators of parent–adolescent communication.

Parent-Adolescent Communication as a Protective Factor Against Adolescent Alcohol and Tobacco Use: Reported Narratives From Youth From Latinx Farmworker Families

Due to high stressors and inequities, youth from Latinx migrant farmworker (LMFW) families may experience an elevated risk of early drinking and smoking. Parent-adolescent communication can protect against early initiation, but few researchers have explored this parenting practice in LMFW families. This qualitative study used youth-reported narratives to examine messages LMFW parents convey when discussing drinking and smoking, if these messages varied by age, youths’ feelings toward these discussions, and if these discussions promoted resilience against drinking and smoking among youth. Twenty-four LMFW youth (67% boys, Mage = 13.88, 79% born in the United States) were recruited from a summer Migrant Education Program in Indiana. Using thematic analysis, five themes were identified from youth interviews: (1) mostly older youth used substances, but nearly all youth stated that parent’s expressed disapproval toward underage drinking and smoking; (2) parent-adolescent discussions left youth feeling positive and confident; (3) parents used consejos to communicate about alcohol and tobacco; (4) parents were lenient toward drinking and smoking in older male teens; and (5) some parents did not offer reasons for why youth should avoid drinking and smoking or rules pertaining to these substances. Our findings have implications for research and interventions aimed at fostering parent-adolescent communication in LMFW families about alcohol and tobacco use.

Parent-Adolescent Communication On Reproductive Health and Sexual Of Adolescent

ABSTRACTIntroduction: In adolescence, there are various changes, both physical, cognitive, and social, which cause adolescents vulnerable to reproductive health problems. The family as the closest part of adolescence is one of the main factors in improving adolescent reproductive health and has a very important role in providing sexual and reproductive health information to adolescents. Objective: to find out the communication between parents and teenagers about sexual and reproductive health. Method: The design used is a systematic review. Journal searches are conducted on online databases such as PubMed, Elsevier, Science Direct, and Google Scholar. Journals, articles, and literature reviews were found using keywords parent-adolescent communication, sexual and reproductive health, adolescents. Results: A total of 7 journal articles selected from 28 articles showed that communication between parents and adolescents regarding reproductive and sexual health was very important to do. However, the implementation is still lacking due to various factors such as lack of parental knowledge, parents lacking in communication skills, the presence of shame, and cultural influences that consider reproductive and sexual health issues as taboo to be discussed with adolescents. Discussion: The communication of parents and adolescents regarding reproductive and sexual health has been widely investigated in various countries. Interventions are needed to improve the quality of communication between parents and adolescents through increasing the knowledge of parents of these adolescents.

Parent Attendance in a Family-Based Preventive Intervention Delivered in Latin America and the United States.

In Latin America, there is an increasing interest in the implementation and dissemination of evidence-based, family-centered interventions to prevent youth behavioral problems. While families' participation in interventions is integral to achieving the interventions' desired impact, little is known about what predicts Latin American families' attendance. The current study provides a unique opportunity to explore the participation of families living in the United States, Ecuador, and Chile in an evidence-based intervention, Familias Unidas. We tested for differences in attendance rates, family functioning variables, and adolescent behavioral problem variables, then applied a hierarchical multiple regression to (a) identify which variables significantly predicted program attendance and (b) assess whether the country in which the intervention was implemented in moderated the relationship between predictors and program attendance. On average, Chilean and Ecuadorian parents were more engaged and attended more sessions than parents living in the United States. Across samples, there was significant differences in family functioning and adolescent behavioral problem variables. However, effective parent-adolescent communication was the only significant predictor of lower program attendance. A significant interaction effect revealed that even though Chilean parents had high parent-adolescent communication, they were more likely to attend sessions, compared to parents living in the United States. We highlight the promise of engaging and retaining families, across U.S. and Latin American samples, into a culturally syntonic, family-based intervention, and discuss potential explanations for success in Chile and Ecuador. Researchers interested in implementing interventions in Latin America could utilize these findings to better target participants and intervention efforts.

Invitational Rhetoric between Parents and Adolescents: Strategies for Successful Communication

ABSTRACTSuccessful parent-adolescent communication is crucial to a young person’s well-being and development, but family communication during adolescence is particularly challenging. One type of conversation employs invitational rhetoric, which describes communication where the goal is not to persuade, but to exchange perspectives by creating an atmosphere that establishes safety, value, and freedom. Up to now invitational rhetoric has been used to understand public communication from a rhetorical perspective, but we apply this theory to family communication. To understand invitational rhetoric in families, participants (N = 113) completed a qualitative questionnaire about communication with their parents. Using the critical incident technique participants provided a detailed narrative about a time that they and a parent had a successful conversation about a difficult topic. The results provide a blueprint for understanding what young adults perceive as contributing to invitational conversations with their parents.

Exploring issues in caregivers and parent communication of sexual and reproductive health matters with adolescents in Ebonyi state, Nigeria

BackgroundParent-child communication is an effective tool for fostering healthy sexual and reproductive behaviours among adolescents. However, the topic is underexplored in Nigeria. This study examines how parents and caregivers communicate sexual and reproductive health-related matters with adolescents aged 13–18 years in Nigeria.MethodThe study was undertaken in six communities in Ebonyi state, Nigeria using quantitative and qualitative research methods. Data were collected through, i) cluster randomized survey of 1057 adolescents aged 13–18 years, ii) twelve sex-disaggregated focus group discussions with adolescents aged 13 to 18 years, and iii) eight in-depth interviews with parents and caregivers. Univariate and bivariate analysis were performed for quantitative data, while qualitative data were analysed using thematic framework approach.ResultsLess than half (47.9%) of adolescents in the survey reported ever discussing sex-related matters with anyone. Three-quarters of those who had this discussion did so with a friend/peer and this had significant correlation with sex/gender (p = 0.04). Out of 1057 adolescents who participated in the survey only 4.5% had ever discussed sex-related matters with a parent and this correlated significantly with wealth index (p = 0.003). Findings from qualitative interviews show that sex-related discussions between parents and adolescents are sporadic, mostly triggered by unpleasant occurrences, and consist of, i) information on pubertal changes, ii) warnings against intersex relationships and premarital sex, iii) promotion of abstinence, and iv) warnings against teenage pregnancy and unsafe abortion. Some parents were of the opinion that sex-related matters should not be discussed with adolescents because it could be interpreted as tolerance for sexual promiscuity. Overall, parents expressed that their capacity to discuss sex-related matters with adolescents is limited by lack of knowledge, and restrictive religious and cultural norms about adolescent sexuality.ConclusionCommunication between parents and adolescents on sexual health and reproductive-related matters rarely occurs. However, when it does, it mostly consists of strict warnings that may not protect adolescents from making unhealthy sexual and reproductive health choices. Interventions to improve parent-adolescent communication of sexual and reproductive health (SRH) should aim at improving parents’ capacity to communicate sexual and reproductive health matters, and deconstructing sociocultural norms around adolescent sexuality.

Adolescent Parent Communication Concerning Sexual and Reproductive Health Issues Among Sendafa High School and Preparatory Students

Globally, adolescents constitute about one billion of the world’s population, with majority living in developing nations. Adolescent parent communication is among several strategies that improves sexual and reproductive health issues. The aim of this study was to determine adolescent-parent communication on sexual and reproductive health issues among Sendafa high school students. Cross-sectional descriptive study was conducted from May to July, 2016 G. C., at Sendafa high school and preparatory students. All unmarried and aged 13-24, who are attending school during the data collection were included in the study. Study participants were interviewed about their socio demographic characteristics and level of communication with their parents using structured questionnaire. Data were checked for completeness and entered into EPI Info and transferred for analysis to SPSS version 20 software. A total of 304 sendafa high school students were assessed for adolescent parent communication regarding sexual and reproductive health issues during study period. The mean age of the respondents was 16.77±1.78SD, with a range of 13- 24 years. 190 (62.5%) of students were agreed on the importance of adolescent parent communication on sexual and reproductive health issues. 163 (55.9%) and 161 (53.2%) of study participants were discussed with their parents on contraceptive method and STI/HIV/AIDS respectively. 155 (50.9%) of respondents reported that they choices their friends, while 62 (20.4%) and 45 (14.8%) of the study participants choices their sister and mother respectively. According to the finding of the present study the parent adolescent communication about sexual and reproductive health issues were low. Therefore, training and education to improve the adolescent-parent communication is recommended for the both.

Adolescents’ Self Esteem in Intact and Single-Parent Families: Its Relation with Parent-Adolescent Communication and Attachment

The developmental of self-esteem is very important for adolescents. The high self-esteem refers to ability to predict the success and well-being of adolescents in their adulthood. This study examines the influence of parents-adolescent communication and attachment on adolescents’ self-esteem in intact and single-parent families. This research design was cross-sectional study and was conducted in public and private high schools and vocational schools in Bekasi City. School selection is done purposively. Participants of this study were 200 students who fit with the criteria which are students of class X - XII with an age range of 14-19 years from selected schools in the city of Bekasi from intact and single families. Data analysis wa done by descriptive and inferential analysis (independent t-test and multiple linear regression test). The results showed that family status has a significant influence on adolescent’s self-esteem. Parent-adolescent communication and parent-adolescent attachment have significant positive influence on adolescent’s self-esteem. The implications of research indicates the importance of support and education for families and adolescents to improve self-esteem, especially in adolescents from a single family, for example, changing negative perceptions to positive (feeling yourself useless, worthless to be useful and valuable for others).

대학생의 내재적동기, 진로결정자기효능감, 진로준비행동의 관계: 부모-자녀 의사소통 수준에 따른 다집단 분석

본 연구는 대학생들이 진로를 결정하고 준비하고 행동하는 것에 있어 겪는 심리적 어려움을 덜어 주고 그에 대한 대안을 모색해 보는 것에 목적을 두고 있다. 이를 위하여 진로준비행동과 관련된 개인적, 심리적 변인들을 설정하고 그들의 구조적 관계를 살펴보았으며, 환경적 변인과의 구조적 관계도 살펴보기 위해 부모-자녀 의사소통의 변인을 설정하였다. 특히, 부모-자녀 의사소통은 평균을 중심으로 고집단, 저집단으로 나누어 각각 다른 변인들 간의 구조적 관계가 어떠한지, 고집단, 저집단 간의 차이는 어떤지 AMOS 21을 통한 다집단 분석을 통해 검증하였다. 그 결과, 내재적 동기와 진로준비행동 사이를 진로결정자기효능감이 부분적으로 매개 하는 것으로 나타났다. 그러나 설정한 매개 모형에서 다집단 분석을 통해서는 부모-자녀 의사소통 고집단과 저집단 간에 유의미한 차이는 나타나지 않았으나 모형의 경로계수를 분석해보면 내재적 동기에서 진로결정자기효능감, 진로준비행동으로 가는 경로가 부모-자녀 의사소통의 저집단이 고집단보다 더 진로준비행동으로 가는 경로를 더 강하게 설명해 주는 것을 확인할 수 있었다. 이는 자신의 진로를 선택하고 결정하는 것에 있어서 대학생들은 점차 부모의 영향력을 벗어나는 것을 의미하며, 대학생이 진로를 준비하고 결정하고 행동하는 것에 있어서 중요한 것은 더 이상 부모의 영향이 아니라 개인의 내재적 동기와 같은 심리내적인 변인이라는 것을 의미한다.

The Influence of Parent Distress and Parenting on Bereaved Siblings' Externalizing Problems.

Bereaved siblings experience more externalizing problems compared to non-bereaved peers and norms; however, the mechanisms explaining this phenomenon have not been empirically examined. This study tested the serial indirect effects of sibling bereavement on adolescents' externalizing problems through parent distress (i.e., internalizing symptoms) and parenting (i.e., parenting behaviors, parent-adolescent communication). During home visits, 72 bereaved adolescents (ages 10-18) whose brother/sister died from cancer and 60 comparison peers reported about their externalizing problems and their mothers' and fathers' parenting behaviors (warmth, behavioral control, psychological control) and parent-adolescent communication (open communication, problematic communication). Mothers and fathers reported their own internalizing symptoms. Bereaved siblings reported more externalizing problems (p =.048) and bereaved mothers reported more internalizing symptoms relative to the comparison group (p =.015). Serial multiple mediation models indicated that elevated externalizing problems were partially explained by both bereaved mothers' internalizing symptoms and parenting and communication (less warmth [CI: 0.04, 0.86], more psychological control [CI: 0.03, 0.66], and more problematic mother-adolescent communication [CI: 0.03, 0.79]), with a significant indirect effect also emerging for open mother-adolescent communication [CI: 0.05, 1.59]. Bereaved fathers did not significantly differ in internalizing symptoms from comparison fathers (p =.453), and no significant indirect effects emerged for fathers. Elevated externalizing problems in bereaved siblings may result from mothers' distress and the impact on their parenting and communication. Targeting adjustment and parenting in bereaved mothers following a child's death may reduce externalizing problems in bereaved siblings. Research to evaluate family-centered interventions is needed.

Parent–teen communication predicts treatment benefit for depressed and suicidal adolescents.

Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents' treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents' likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents' response to 2 treatment conditions. The sample consisted of 129 depressed and suicidal adolescents (Mage = 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent-adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent-adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Mediating Effect of Resilience in the Relationship between Parent-Adolescent Communication and Self-Esteem

The Mediating Effect of Resilience in the Relationship between Parent-Adolescent Communication and Self-Esteem

Iranian Adolescent Girls' Perceptions of Premarital Sexual Relationships: A Qualitative Study

Sexual perception refers to the attitudes, expectations, beliefs, and values associated with sexual behaviors. Adolescents’ sexual behaviors is affected by the knowledge, attitudes, values, beliefs, and social norms in their society. In this respect, the sexual perception of adolescents can be studied from a cultural perspective. The present study was designed to identify factors affecting Iranian adolescent girls’ perceptions of premarital sexual relationships. A qualitative study was conducted using a conventional content analysis approach. Data was collected using in-depth unstructured interviews with 18 adolescents recruited through purposive sampling. Data analysis resulted in the development of a primary main theme, meaning and value of sexual self-care, and three main categories: significant others, sexual norms, and attitudes, and perceived risks. Overall, findings of the present study revealed that the sexual perceptions of Iranian adolescent girls motivated them to abstain from premarital sexual relationships. However, apart from the perceived double standards involved in social norms and attitudes identified in the study, the presence of a conflict caused by their families, schools, and peers necessitated the importance of establishing and consolidating parent-adolescent communication about sexual issues. Findings of this study point to the need for appropriate sexual education for adolescents and parents to promote adolescent sexual literacy and health.

Does Adolescent Anxiety Moderate the Relationship between Adolescent–Parent Communication and Adolescent Coping?

Parent-adolescent relationships support the development of adolescent coping styles, but this support may be impacted by parent and adolescent gender, as well as by the presence of anxiety symptoms. This study examined the moderating role of adolescent anxiety symptoms for the longitudinal relationship between adolescent–parent communication with mothers and fathers and adolescent coping styles. Surveys were administered to 1034 high school students (Mage = 16.16, SD = 0.75; 55% girls; 58% White) in the spring of 2007 (T1) and spring of 2008 (T2). Results indicated that adolescent–mother communication positively predicted the development of coping styles, particularly for boys’ emotion-focused coping styles. In contrast, adolescent–father communication negatively predicted some emotion-focused coping styles for boys, including venting coping, emotional social support seeking coping, and religious coping. Adolescent–father communication did not predict any coping styles for girls. Anxiety moderated relationships, such that adolescent–mother communication positively predicted the development of girls’ and boys’ coping styles only in the context of low anxiety symptoms. For boys, adolescent–father communication predicted more venting coping and religious coping when adolescent anxiety symptoms were high. These findings point to complex gender differences in the social development of adolescent coping styles, and these findings underscore the need to examine parent and adolescent gender differences.

Parent–adolescent communication and Chinese adolescents’ self-esteem: A cross-lagged model

We investigated the reciprocal relationship between parent–adolescent communication and adolescents’ self-esteem with a sample of 296 Chinese junior middle school students over a course of approximately 3 months, using an autoregressive cross-lagged model. The results showed that both parent–adolescent communication and adolescent self-esteem had invariant autoregressive effects over the 3 months. In addition, parent–adolescent communication had a significant crosslagged effect on adolescent self-esteem and vice versa, indicating reciprocal effects between parent–adolescent communication and adolescent self-esteem over time. Our findings suggest that multilevel intervention incorporating individual counseling and family intervention is more effective in improving parent–adolescent communication and adolescent self-esteem than either individual counseling or family intervention alone.