Study shows Latino and Black fathers' perception of sons' sexual readiness is key to effective condom guidance

A new study from Annals of Family Medicine reveals that a father's understanding of his son's readiness for sexual relationships plays a crucial role in the timing and effectiveness of discussions regarding condom use guidance. The findings offer valuable insights for family-focused health care providers, guiding them to encourage fathers to initiate conversations about sexual readiness and the importance of correct and consistent condom use with their adolescent sons.

In 2021, 47% of adolescent males in the 12th grade reported engaging in sexual activity, yet condom use has declined. These trends contribute to negative sexual health outcomes among young men. For example, adolescent males aged 15–19 years account for more than 100,000 diagnoses of reportable STIs per year. Latino and Black adolescent males experience inequitable access to, and quality of, health services related to sexual health outcomes, including STIs, HIV, and unplanned adolescent parenthood.

Fathers play a crucial role in promoting adolescent male sexual health, yet minimal father-focused and condom-specific communication resources are available to care teams delivering family-centered health services. Researchers from the Institute for Policy Solutions at Johns Hopkins School of Nursing set out to examine the factors that shape Latino and Black fathers' decisions about when to initiate condom guidance with their sons.

To explore this, researchers recruited 191 Latino and Black adolescent males aged 15–19 years and their fathers in the South Bronx, N.Y. Both fathers and their sons completed a survey. A subset of fathers participated in audio-recorded sessions with a father coach, which included conversations about adolescent male condom use.

The study found that paternal perceptions of their sons' readiness for sex are an important predictor of the provision of condom guidance. This decision is based on more than just their son's age or whether they perceive their son as sexually active; fathers also consider other maturity factors when deciding if their sons are ready for sexual relationships, including (1) completion of important milestones related to their long-term life opportunity trajectories, (2) cognitive–social–emotional maturity, and (3) preparedness to have sex safely. Additionally, inconsistencies between paternal perceptions of readiness and actual adolescent male-reported sexual activity were found to be common.

These findings underscore the importance of family health care provider–initiated interactions with fathers regarding the provision of condom-specific guidance to their sons. Discussions around adolescent male readiness for sex should remind fathers that providing guidance about correct and consistent condom use is not synonymous with encouraging their sons to have sex and that these conversations, as a protective measure, can and should occur before major developmental milestones and full cognitive–social–emotional maturity are reached.

"Discussing paternal notions of adolescent male readiness for sex might be a good way for family-focused health care providers to get fathers involved in protecting their adolescent sons' sexual health," said Vincent Guilamo-Ramos, a nurse practitioner who specializes in adolescent sexual health and study lead author who is Executive Director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing.

This study provides practical suggestions for engaging fathers in primary care and represents a novel approach to increasing condom use and reducing negative sexual health outcomes among male adolescents. The recommendations are examples of the evidence-informed solutions that nurses are well-equipped to develop and provide, including:

• Explicitly encouraging fathers to be pre-emptive and not reactive in giving condom guidance to their adolescent sons. While there is no universal, specific age to start this conversation, fathers should be ready to start regular communication about the importance of sexual health before an adolescent starts having sex.
• Emphasizing that correct and consistent condom use is part of a comprehensive strategy for preventing negative academic, economic, and social consequences of unprotected sex among adolescent males and supports their son's future goals and life opportunities.
• Reminding fathers that talking about condoms is not synonymous with encouraging their sons to have sex. In contrast, fathers who communicate with their adolescent sons about sex early during adolescence and regularly reduce the chances of their son's starting to engage in sex too early. Encouraging fathers to clearly communicate their expectations about correct and consistent condom use if their son is sexually active increases the chances that the adolescent male will protect himself from risky sexual activity.
• Ensuring that fathers know how to start the condom conversation, can demonstrate how to use a condom correctly, are willing to provide condoms to their sons, and are comfortable with encouraging their sons to practice using a condom.